Order Form
Please fill in as much as you can. It is not required; however, the more information that can be supplied will help us to supply you with the correct hose.
Contact Name:
Company Name:
Phone Number:
Fax Number:
Email:
Size:
Inside Diameter
Outside Diameter
Length
Temperature:
Highest
Lowest
Application:
How is hose being used?
(Factory Chemical Transfer, Outside Water Discharge or Sucrtion,Tank Truck or Rail Car Unloading, Factory Steam, Petroleum Transfer, Papermill Washdown, etc.)
Environmental or Installation considerations
Unusual Needs
(High Vibration, Tight Bend Radius, Non-Marking Cover, etc.)
Media:
What is going through the hose?
Pressure:
Actual Working Pressure(+)
Spikes
Suction (-)
Ends:
Fittings
Thread Size
Size
Material
(Stainless Steel, Brass, Carbon Steel, Polypropelene, etc.)
Delivery:
Quantity Required
Date Required
Ship Via
Ship To
Fabricated Flex & Hose
2037 Palmer Avenue
Kalamazoo, MI 49001
800.656.9292
269.342.2221
269.342.2260 FAX
info@fabflexhose.com
Fabricated Flex & Hose Tel. 800.656.9292
info@fabflexhose.com
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© 2008 Fabricated Flex & Hose