Name:
Title:
Company:
Street Address:
Street Address (cont.):
City:
State/Province:
Zip/Postal Code:
Country:
Phone:
Fax:
E-mail:
Industry:
Your Company is a:	OEM  End User  Distributor  Other
Your Need is:	Immediate  Within 3 months  Over 3 month
Application Description:
Reducer Shaft Orientation:	Horizontal  Vertical  Other
Reducer Shaft Configuration:	In-Line  Right-Angle  Either
Backlash Level Required (Arc-Min):	≤ 1  ≤ 2  ≤ 6  ≤ 12  Doesn't Matter
Reduction Ratio Needed:	:1
Output Style:	Hollow-Bore  Solid Shaft  ISO Flange
Maximum Output Speed Needed:	revolutions per minute
Maximum Output Torque Needed:	lb.ft.  or:  Nm
Driven by Output:	Coupling  Pulley/Gear/Belt  Chain  Ballscrew  Other
Operating Time:	Intermittent  < 8 hours/day  < 16 hours/day  24 hours/day
Operating Environment:	Clean  Dirty  Outdoors  Other
Motor Selected (if any):
Motor Speed:	rpm
Nominal Motor Torque:	in.lb.