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CUSTOMER INFORMATION

Company:

Contact:

     Phone:

      Fax:

E-Mail:

APPLICATION REQUIREMENTS

Inner Diameter:    Overall Length:    Operating Temperature:F

Liner Required?

Yes  No

Liner Material:

  

Cover Required?

Yes  No

Cover Material:

  
MATERIAL

Internal flow media:

Hose Material:

Braid Layers:

PRESSURE

Working Pressure:    Pressure Type: Constant  Shock  Pulsating  Intermittent 

END FITTINGS

Fitting #1:    Size:   Type:   Material:  

Fitting #2:    Size:   Type:   Material:  

DELIVERY

Quantity:   Requested Ship Date:

Please describe any special requirements below.

    

 

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State Metal Hose

4171 Lyman Dr.    Hilliard, Ohio 43026

Phone: (614) 527-4700    Fax: (614) 527-4701    Email: Info@StateMetalHose.com