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Customer Information:
Name:
Title:
Company:
Address:
City:
State:
Zip:
Phone:
Fax:
Application/Type of Equipment:
Present Seal:
Customer Information:
Static
Dynamic
Reciprocating
Oscillatory
Rotary
Single Acting
Double Acting
Temperature:
Pressure:
Stroke:
Cycle:
R.P.M.:
Speed:
SideLoad:
Hardware:
Gland Design
Separable
Not Separable
Adjustable
Fixed Cavity
Piston Design
Solid
Split
Wiper
Snap In (Type :
Wiper
Guide Rings
BackRings
Gaskets
Rod Seals
Piston Seals
Rotary Seals
)
Press Fit (Bore :
Wiper
Guide Rings
BackRings
Gaskets
Rod Seals
Piston Seals
Rotary Seals
, Recess :
)
Wear Ring
Required
Not Required
Description
MM/Inch
Material
Bore Diameter
Rod Diameter
Groove Diameter
Piston Diameter
Groove Width
Problem with present seal:
Delivery
Installation
Dimensional Quality
Others (please explain):
Short Life
Excessive Wear
Price
Material Failure
Excessive Leakage
Supplier Service
Notes:
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