1. Type of device:Clutch Brake Clutch/Brake Other
2. Torque:oz-in n-m
3. Voltage:
4. Power Dissipation:(in Watts)
5. Electrical Connection: Terminals Wire leads
6. Mounting Style:
7. Ambient Temperature:°C°F
8. Model Size:4 6 8 10 12 26 28 30 32 34 Other
9. Special Requirements:
10. Environmental Requirements:

1. Describe Application:
2. What size best fits your space limitations?
3. Estimated amount of FORCE: lbs
4. Working STROKE? inches
5. DUTY CYCLE :100% 50% 25% 10%
   Estimate "on" time and "off" time
6. Ambient Temperature:°C°F
7. Mounting Preferred:
   Describe:
8. Type of connection to the PLUNGER intended: :
9. Is RETURN SPRING required? Yes No Force
10. OPERATING VOLTAGE: DC
11. MAXIMUM CURRENT(in amps) or MAXIMUM POWER(in watts)
12. Special Requirements:
13. Normal life cycle Requirements:
14. Estimated Quantities:Prototype Production
15. Is this a new application, or a revision of an existing application? New Existing
16. Best time to contact: Day(MM/DD) Time(HH:MM) AM PM

Any Additional information not covered above: