Customer Request for Quotation

Please provide the contact information below

Company Name:		Address:
Contact Person(s):		Phone Number:
Fax Number:		Email Address:

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Please provide the required information below

Quantity:
Application:		New Application: (describe)
		Existing Application: (describe)
Style:		Double Acting		Single Acting (load return)
		Push		Pull
Mounting Flanges:		Yes		No
Lengths: (complete 2 of 3)		Overall:
		Collapsed:
		Extended:
Specifications: (complete all)
		Stroke:
		Bore Size:
		Rod Size:
		Number of Stages:
		Operating Pressure (PSI):

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Please provide the information below if possible

Rod End Style:	Please Select One Pin Eye Clevis Male Thread Female Thread Cross Tube
Tube End Style:	Please Select One Pin Eye Clevis Male Thread Female Thread Cross Tube
Force:		Retract Force:
		Extend Force:
Valves Requirements:		Pilot Operated Check		None Required
		Relief		Counter Balance
Ports:		Size:
		Type:
Delivery Requirements:
Additional Notes:
Special Considerations: