Rotary Seal Design Guide - Seals Unlimited

Design Action Request FormCatalog EPS 5350/USAAANEED HELP? If you need assistance, please photocopy these three pages. Fill out the requiredinformation and fax to (936) 560-8998. Use the information below and other information in this catalog todetermine the dimensions needed. We will contact you to discuss your specific application and makerecommendations. If you need help filling out this form, please call Applications Engineering at(800) 233-3900.ENGINEERED POLYMER SYSTEMS DIVISIONDESIGN ACTION REQUESTReferred by _________________Lead #_____________________Applications Engineering Use:Project # ____________________________Date Entered ________________________Date Required _______________________Prepared by _________________________Territory Mgr. ________________________Distributor ___________________________Distributor ___________________________Dist. Sales __________________________COMPANY: ___________________________________________ FAX NUMBER:_________________________________________ADDRESS: ___________________________________________ P.O. BOX:______________________ MAIL STOP: __________CITY: _________________________ STATE: ______________ ZIP:___________________________ COUNTRY: ___________CONTACT: ____________________ TITLE: _______________ PHONE: _______________________ EXT:_________________ALT. CONTACT: ________________ TITLE: _______________ PHONE: _______________________ EXT:_________________E-MAIL: ______________________________________________EQUIPMENT/MANUFACTURER: _________________________________________________________ MODEL NO.:_____________EXISTING SEAL MANUFACTURER: ______________________________________________________ PART NO.: ______________REASON FOR CHANGE: PERFORMANCE DELIVERY NEW APPLICATION PRICECURRENT PRICE: ________ @ _____ PCS. MONTHLY USAGE: _____ HOURS OPERATION: _____ HOURS SERV. LIFE: _____TARGET PRICE: ________ @ _____ PCS. QUOTE QTY.: _____ PROTO QTY.: _____ DATE PROTO REQ’D.: _____SPECIAL INSPECTION REQUIREMENTS: YES NO SPECIAL PACKAGING REQUIREMENTS: YES NOEXPLAIN: _____________________________________________________________________________________________________MOTIONSTATIC RECIPROCATING OSCILLATORY ROTARYPRODUCT TYPENON-ROTARY — FILL OUT SECOND PAGEROD/SHAFTWIPERPISTONBEARINGINTERNAL FACE VANEEXTERNAL FACE NON-SEALROTARY — FILL OUT THIRD PAGESOLID SEALPTFE LIP SEALSPLIT SEALELASTOMER LIP SEALBEARING ISOLATOR03/28/06A-1 Parker Hannifin CorporationEPS DivisionToll Free: (800) 233-3900www.parkerseals.com