Quotation Request Form

General Information

•Firm Name:

•Company Executive:

•Phone:

Fax:

Mobile:

•E-mail Address:

Product Requested

Job Definition:

Quantity:

Hydrolic Cylinder Pnumatic Cylinder Spare Part Repair Other

Cylinder Information

Barrel: mm

Rod: mm

Stroke: mm

Closed Height: mm

Operating Pressure:

Temprature:

Seals:

Operating Fluid

Mineral Oil Boron Oil + Water

Other:

Type of Connection:

Sectors of Use:

Explanations:

Information on products requested other than cylinder

Dimentions:

Material Quality:

Explanations:

•: Indicates fields obligatory to be filled.