Hose Selection Form

Hose Selection Form

Thank you for filling out our Hose Selection Form. Please submit this form or print it and return it to Central Equipment. Call us with any questions at 315-776-5300. Email: Info_Central@Yahoo.com Fax: 315-776-8800
*Here's What We Need From You: SIZE, TEMPERATURE, APPLICATION, MATERIAL, PRESSURE, ENDS & DELIVERY
Name
First Last
Company
Phone
Email
Size
Hose Size:
Inside Diameter (I.D.):
Outside Diameter (O.D.):
Cut Length or Coupled Length (OAL):
Temperature
Transferred Product Temperature / MIN:
Transferred Product Temperature / MAX:
Environment Temperature / MIN:
Environment Temperature / MAX:
Application
How is Hose Being Used?
- Suction
- Discharge
- Pressurized
Material
Material Going Through Hose:
Pressure
Max Pressure (PSI) or Suction (IN/HG):
Ends
Fittings or Open Ends:
Delivery
When:
Quantity (ft):
Other:
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Size