jobst
incorporatedHOSE AND TUBING APPLICATION QUESTIONNAIRE
Fill out this form and fax it us: 978-945-6121 or e-mail to sales@jobstinc.com
We will promptly contact you with a solution so make sure and fill in your contact information at the bottom of the page.
HOSE AND HOSE ASSEMBLIES
Application:____________________________________________________________________
ID: _____ OD:_____
Material, Tube: __________________ Material, Cover: _________________ Rein.:___________
Working Pressure: _________________Burst Pressure:_________________________________
Temperature Range: _______________Couplings:_____________________________________
Color.: __________________________ Printing:_______________________________________
Put-up (packaging): ______________________________________________________________
Quantity: ________________________ Releases:______________________________________
TUBING or CUT WASHERS
Application:____________________________________________________________________
_____________________________________________________________________________
ID: _________OD: _______ Wall: _______ Cut or. Length: _____________
Material: ___________________________ Durometer: ____________
Temperature Range.: __________________________ Color:_______________________________________
Put-Up: _________ Quantity: _________ Releases:______________________________________
Other Specs: __________________________________________________________________
Are Prints or Samples available for comparison and quoting purposes? ___________
How did you hear about us?____________________________________________
Your name: _______________________ Title: _____________________________ Company: _______________________ Dep't/Mailing Station: ________________ Address:__________________________________ Telephone: _______________ E-mail: ___________________________________ Fax: ____________________
jobst
incorporated • po box 8 • prior lake • mn • 55438 • 952-447-3904 • 978-945-6121 sales@jobstinc.com • www.jobstinc.com