* Required fields

Hose of Teflon® Application Guide

*First Name		*Last Name
*Company		Fax
*Address 1		Phone
Address 2		Ext.
*City		*Province/State
Postal Code
*Country
*E-mail
	Call me.	E-mail me.
Description of application (Include type of equipment plus description of Fluid system.)
Hose & Size (if known)		Overall Length
If size is unknown, specify fluid and flow rate
Fitting Requirements (size, material, type)
One End
Other End
Fluid being conveyed
Fluid Temperature °F Max    °F Min.    °F Normal
Temperature of surrounding atmosphere °F Max    °F Min.
Fluid Pressure PSI       Vacuum (inches Hg)
Pressure Cycle   PSI Max.    PSI Min.    Frequency
Surges (please explain)
Installation Description
Static Bend Radius    Flexing Application Bend Radius
If flexing is involved, please specify the following:
Frequency:    Amplitude of Motion
Additional special requirements
Sleeve or guard required
Other factors involved
Number of units required