Checklist for rubber parts - FUCHS LUBRITECH GmbH

Dear Customer,
CHECK-LIST FOR ELASTOMER COATING
In order to carry out your sample coating we kindly ask you to fill in the following details.
(PLEASE COMPLETE IN BLOCK LETTERS)
Without the information on the check-list it is not possible to carry out sample coating.
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1. General customer data:
Company
Contact person
Department
Street
Post Code and
Location
Telephone
number
Fax number
E-mail address
2. Please forward this check-list and supplementary information to:
FUCHS LUBRITECH GmbH
Export Department
Werner-Heisenberg-Straße 1
D-67661 Kaiserslautern
e-mail: customerservice.export@fuchs-lubritech.de
3. Information about the component function / area of application (if possible enclose drawing or sketch)
Description:
To what stresses is the component / the system subjected?
Surrounding media (e.g. dust, salt water, oil, air etc.)
FUCHS LUBRITECH GmbH Board of Management Head office FLT Surface Technology Graphite Products
www.fuchs-lubritech.com Dipl.-Ing. Bernhard Biehl Werner-Heisenberg-Str. 1 Königsberger Str. 2a Braugasse 1
Register of company (Chairman) 67661 Kaiserslautern 85386 Eching 01809 Dohna
Kaiserslautern, HRB 1413 Dipl.-Wi.-Ing. Markus Heck T: +49 (0) 6301 3206-0 T: +49 (0) 89 32710-5 T: +49 (0) 3529 5646-
30VAT Ident. No. DE811197454 Dipl.-Kfm. Tim Weidenmann F: +49 (0) 6301 3206-940 F: +49 (0) 89 32710-640 F: +49 (0) 3529 5646-40

Type of movement (e.g. sliding)
Operating temperature range from ° C to ° C
static sealing
dynamic sealing (number of cycles)
Cold water
Hot water
Contact with foodstuffs
Miscellaneous
4. Information concerning the component to be coated
Component drawing / drawing number:
Sketch (if necessary use a separate sheet or mail us photos)
Dimensions:
Information relating to the elastomeric material to be coated
material type (e.g. NBR, EPDM …): __________ hardness (Shore A): _________
Cross linkage:
Sulphur cross-link Peroxide-cured
Manufacturer of the elastomer material
Own manufacture
Supplier:
Company
Contact person
Department
Street
Post Code and
Location
Telephone
number
Fax number
E-mail address
What must be taken into account regarding the component / its use?
FUCHS LUBRITECH GmbH Board of Management Head office FLT Surface Technology Graphite Products
www.fuchs-lubritech.com Dipl.-Ing. Bernhard Biehl Werner-Heisenberg-Str. 1 Königsberger Str. 2a Braugasse 1
Register of company (Chairman) 67661 Kaiserslautern 85386 Eching 01809 Dohna
Kaiserslautern, HRB 1413 Dipl.-Wi.-Ing. Markus Heck T: +49 (0) 6301 3206-0 T: +49 (0) 89 32710-5 T: +49 (0) 3529 5646-
30VAT Ident. No. DE811197454 Dipl.-Kfm. Tim Weidenmann F: +49 (0) 6301 3206-940 F: +49 (0) 89 32710-640 F: +49 (0) 3529 5646-40

Avoid a temperature below _____ °C / above _____ °C
Miscellaneous
5. Requirement profile for the coated part:
Coating for the purpose of assisting installation
Durable function lubrication
Planity
Requirements for the component’s dimensional stability (distortion)
Should the component’s sticking tendency be inhibited?
6. As part of our sample coating service we will suggest one or more coating processes. If you wish to have a
quotation for custom coating at our works we would ask you to provide the following additional information:
Number of items per year
Number of items per delivery
Part weight, if applicable
Other requirements
7. Packaging:
Original packaging can be re-used if
it is free from oil and grease
it is not soiled
Original packaging should not be re-used
Requirement with regard to packaging
Possible requirement on the part of the customer for cleanliness
(no bits of paper, etc.)
Humidity-resistant packaging material
Other requirements
Customer will provide suitable receptacles
For all other matters our General Terms and Conditions of Supply apply, which you can consult under
FUCHS LUBRITECH GmbH Board of Management Head office FLT Surface Technology Graphite Products
www.fuchs-lubritech.com Dipl.-Ing. Bernhard Biehl Werner-Heisenberg-Str. 1 Königsberger Str. 2a Braugasse 1
Register of company (Chairman) 67661 Kaiserslautern 85386 Eching 01809 Dohna
Kaiserslautern, HRB 1413 Dipl.-Wi.-Ing. Markus Heck T: +49 (0) 6301 3206-0 T: +49 (0) 89 32710-5 T: +49 (0) 3529 5646-
30VAT Ident. No. DE811197454 Dipl.-Kfm. Tim Weidenmann F: +49 (0) 6301 3206-940 F: +49 (0) 89 32710-640 F: +49 (0) 3529 5646-40

http://www.fuchs-lubritech.com/download/agb.pdf
or http://www.fuchs-lubritech.com/download/agb_eching.pdf.
Please observe special notes in our quotation, if applicable.
Date Signature
.
We will select the most suitable coating process as well as the best possible coating medium on the basis of the
information given in this check-list.
We will then get in touch with you again to agree how the coating of the sample is to proceed.
FUCHS LUBRITECH GmbH Board of Management Head office FLT Surface Technology Graphite Products
www.fuchs-lubritech.com Dipl.-Ing. Bernhard Biehl Werner-Heisenberg-Str. 1 Königsberger Str. 2a Braugasse 1
Register of company (Chairman) 67661 Kaiserslautern 85386 Eching 01809 Dohna
Kaiserslautern, HRB 1413 Dipl.-Wi.-Ing. Markus Heck T: +49 (0) 6301 3206-0 T: +49 (0) 89 32710-5 T: +49 (0) 3529 5646-
30VAT Ident. No. DE811197454 Dipl.-Kfm. Tim Weidenmann F: +49 (0) 6301 3206-940 F: +49 (0) 89 32710-640 F: +49 (0) 3529 5646-40