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Title: 

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1. Describe your application



2. Valve Type:   2 way   3 way   NO   NC   Proportion 

3. Plug in:   Cartridge Style   In Line   Butterfly Valve   Other (describe in remarks section) 

Performance Requirements

1. Fluid: 

2. Pressure:  Operating  psig  Proof  psig  Burst  psig

3. Flow Requirement:    SCFM   PPH   GPM

4. Leakage Allowed:  None   Minimal (describe in remarks section) 

5. Duty Cycle:   Continuous Duty   75% Duty   50% Duty   25% Duty

if intermittent, max. cycle "on" time  seconds,  min. cycle "off" time  seconds.

6. Operating Life:  Cycles

Electrical Requirements

1. Operating Voltage:   D.C.   A.C.    min    max 

2. Current: Actuating  amps max

3. Watts:  max

Environmental Requirements

1. Ambient Temperature*:   min    max   F   C 

2. Media Temperature*:   min    max   F   C 

Mechanical Requirements

1. Max. valve size:   length   width   depth    inches   cm 

Ordering Information

Quote on following quantities*:  Prototype   Production 

Price Range per unit (Target):   @   Annual

Date this quote is required by:  

Remarks: