Poly
Mod
® Technologies Inc.
P.O. Box 10180
Fort Wayne, IN 46851-0180 USA
Phone: (260) 436-1322
Fax: (260) 432-6051
Email: PolyModCZ@comcast.net
Reciprocating Inquiry Data Sheet (IDS)
All information submitted on this IDS including any attached information, such as hardware drawings, will be considered confidential information and treated as such by
Poly
Mod
® Technologies Inc.
NOTE:
Fields and sections marked by an asterick (
*
) are mandatory.
*
Name:
*
Title:
*
Company:
Division:
*
Address:
P.O. Box:
*
City:
*
State/Providence:
*
Postal Code:
*
Country:
*
Phone:
*
Fax:
E-mail:
APPLICATION:
*
Please check one:
New
Currently In Use
*
Equipment:
Model:
Components:
*
Describe
Application:
Existing Seal
Type:
Material:
Manufacturer:
Part Number:
What has been tried in the past with this application?
*
REASON FOR INQUIRY:
Improved Properties (Please check most critical lines and list values):
Friction - Breakout
Friction - Dynamic
Stiction
Wear
Strength
Creep Resistance
Modulus
Impact / shock
Chemical Resistance
Temperature Resistance
Test Program
(supply details)
Moisture Absorption
Problem with current seal/design (describe):
New Design
Cost Reduction Current cost: $
@
pcs Target cost: $
@
pcs
Quote Request:
Prototypes Qty:
Production Qty:
Usage/Year:
Date Parts Required:
Problem (describe):
Notes:
*
HARDWARE SPECIFICATIONS:
Please specify dimensions, tolerances, and overall shape. If possible, please E-mail us your specifications (link at the bottom of this request) or fax drawings/sketches to 260-432-6051.
Hardware drawings will be E-mailed to PolyModCZ.
Hardware drawings will be faxed (1-260-432-6051).
Hardware drawings are unavailable at this time.
*
Can hardware be changed?
No
Yes If Yes, how?
*
Gland type:
Split
Open
Closed
Stepped
Mil-G-5514
AS4716
Dash Size:
Back-up Width:
Number of Back-ups:
Material:
*
ENGINEERING DATA:
Operating Parameters
Unit
(Select One)
Minimum
Operating
Maximum
Temperature:
°F
°C
Pressure:
psi
bar
MPa
Pressure Direction:
Unidirectional
Bidirectional
Load:
Lbs
kg
Constant
Fluctuating
Shock
Stroke Length:
inch
mm
Cycle Rate:
/min
/hr
/hz
Velocity:
ft/min
mm/min
Vacuum:
in.
Hg.
Torr
Material:
Finish:
Mating Surface:
Finish:
Fluids/Gasses (specific type):
Contaminants:
Lubrication (specify type):
*
PERFORMANCE REQUIREMENTS:
Friction:
Lbs
oz
g
Breakout
Dynamic
Torque:
ft/lb
in/oz
g/cm
Breakout
Dynamic
Required Life:
Cyc
hrs
yrs
Max. Leakage:
drops
cc/mm
Most Critical Aspect:
TEST PROGRAM:
Start Date:
Anticipated Completion Date:
Test Details:
*
DECISION AND TIMING:
*Will decision be made by:
Engineering
Marketing
Purchasing
Other
*Estimated:
Prototype order need date and quantity:
First production need date and quantity:
OTHER DETAILS:
To Email your Drawings/Specifications, click this link prior to submitting the form.
PolyModCZ@comcast.net
