Product Requests Company * Name * First Name Last Name Phone (###) ### #### Fax (###) ### #### Email * Required Prototype Quantity * Estimated Annual Usage Date Quote Requested By MM DD YYYY Details Application Type & Description * Application Type Seal Handling (clamp, hold, lift, press) Seal Against Please Select Gas Steam Water Other Air N/A Handling Application Seal Material Please Select CR/Neoprene(Chloroprene) EPDM/EPM(Ethylene-Propylene) FVMQ (Fluorosilicone) NBR (Nitrile) SBR (Styrene-Butadiene) Viton (Fluorocarbon) VMQ (Silicone) Butyl (Polyisobutylene) Other Pressure Differential or Required Handling Force (psi) Expansion Type Please Select Round Axial Expansion Radial Outwards Expansion Radial Inwards Expansion Straight Seal Custom Required Expansion/Gap Distance (in.) Frequency of inflation (hr) Duration of inflation (min) Temperature at Seal (F) Please provide any applicable notes about chemicals or environmental factors Shape If you have a custom sketch or schematic to provide, please select the last option and we'll follow up with a file request Please Select Cylindrical Rectangular Straight NBR (Nitrile) Other/Custom Bladder or Seal Circular/Endless Weiler Profile Number Weiler product number as shown on website Air Fittings OD Thread Type Please Select NPTF NPSM UNC UNF Other No Thread OD, if Not Threaded (in.) ID Thread Type Please Select NPTF NPSM UNC UNF Other No Thread ID, if Not Threaded (in.) Fitting Length (in.) Material Please Select Aluminum Brass Stainless Steel Other Any comments or additional requirements? Thank you! Feel free to contact us with any questions about the request process.
