Company Name*: 

Individual Name*:   Email*: 

Title: 

Telephone*:  Ext:  Fax: 

Address*: 

City*:  State*:  Zip Code*: 

A. Valve Type

1. Describe your application



2. Relief Valve Type: (check all that apply)

 Direct Acting, Poppet Type
 Direct Acting, Differential Area
 Cartridge Type
 Other 

B. Performance Requirments

1. Fluid Type*: 

2. Pressure*:   Operating  psig   Proof:  psig   Burst:  psig

3. Cracking Pressure:  PSID

4. Full Flow:    GPM  SCFM   PPH 

5. Full Flow Pressure Drop:  PSID

6. Reseat Pressure:  PSID

7. Leakage Allowed at Reseat:  cc/min

8. Leakage Allowed at 75% Cracking Pressure:  cc/min

9. Cycle Life:  cycles

C. Mechanical Requirements

1. Maximum Valve Size:  inches  cm 

Length:  Width:   Depth: 

D. Enviroment

1. Temperature*:  to    F  C 

E. Ordering Information

1. Quote Quantities*:   Prototype   Production 

1. Price Range per Unit (Target):     @  Annual

F. Additional Information or Special Requirements