DATE:


COMPANY:


NAME:


POSITION:


ADDRESS:

PHONE (S):


FAX:


MOBILE:


E-MAIL:


Notes:


BARREL
(See image above)
BORE SIZE(A)


LENGTH (B )


MAX O.D. (C )


FLANGES
Y
N

MAX DIA OF FLANGES :


Screw
O.D. (A )


SHIPPING INSTRUCTIONS

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