| *** Customer Name: |
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| *** Company: |
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| *** Phone Number: |
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| Fax Number: |
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| *** E-Mail Address: |
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| Product
Information |
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| Ambient Conditions: |
Dirty / Dusty
Washdown (Food Handling)
Chemicals That Will Contact Roller and/or Bearings
Oily
Clean Room Class
Other |
| Hours of Operation: |
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| Roller & Bearings Information |
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| Quantity Required: |
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| Part Number: |
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| Roller Length or Between Frame (BF) Dimension: |
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| Roller Diameter: |
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| Conveyor Speed (feet per minute): |
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| Load Per Roller: |
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| Operating Temperature: |
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| *** Tube Material: |
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| Impact Loading: |
Yes
No |
| Material of Shaft: |
Material (stainless, steel, zinc)
Hex
Round |
| Bearing Configurations: |
Stainless(44C, T-304, T-316)
Precision
Commercial
Sleeve Bearing |
| Give a brief description as to the application: |
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| Will the product be side transferred from or onto rollers? |
Yes
No |
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