FIRST NAME
LAST NAME
COMPANY NAME
EMAIL
PHONE NUMBER
COUNTRY United States Canada Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czech Republic Côte d’Ivoire Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong S.A.R., China Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao S.A.R., China Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Réunion Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu U.S. Virgin Islands Uganda Ukraine United Arab Emirates United Kingdom United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican Venezuela Viet Nam Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe
STATE/PROVINCE Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northwest Territories Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Yukon
CITY
POSTAL CODE
SIZE OR ESTIMATED FLOW REQUIRED Please provide either the size or estimated flow required and state which value following this format (# size OR # estimated flow required)
CONNECTION Select One Threaded Shaft Quick Release Flange Mount
THREADED SHAFT TYPE Select One NPT UNF BSP ISO228 Metric
THREADED SHAFT DIRECTION Select One Left Hand Right Hand
PRESSURE Please provide Pressure in psi or bar following this format (# psi OR # bar)
SERVICE TEMPERATURE RANGE Please provide low to high service temperature range (please indicate F or C).
PRESSURE OR TEMPERATURE FLUCTUATE Does pressure or temperature fluctuate or change during operation? If so, please give maximum, minimum and description.
SPEED Please provide Speed in RPM or ft./min. following this format (# RPM OR # ft./min.)
MEDIA TO BE USED Select One Water Steam Air Hot Oil Hydraulic Oil Combination of Media Above Other
IS MEDIA FILTERED? Select One Yes No
MEDIUM DETAIL Is medium abrasive, corrosive, flammable, explosive or toxic? If so, please explain.
FLOW Select One Single Flow Dual Flow Multiport
SIPHON TYPE Select One Stationary Rotating
POTENTIAL USAGE
APPLICATION USE Select One End User OEM Distributor Other
ADDITIONAL COMMENTS Any problems? Any other information regarding application and requirements of the rotating joint. Please describe.
PRIVACY POLICY I HAVE READ AND AGREE TO THE PRIVACY POLICY
DOUBLE OPT-IN I AGREE TO RECEIVING MARKETING EMAILS FROM COLUMBUS MCKINNON IN THE FUTURE, INCLUDING PRODUCT INFORMATION AND NEWSLETTERS.
Comments