Date
    
Company
    
Contact
    
Address
    
phone
        
Fax
    
E-mail
    
Homepage
    


Customer applications?

   

What mechanism is the
motor driving in the applications?

    

New or Existing?

   
If existing, who is the current supplier?
    
Is unit available for test?
   
Are there any problems or concerns
with the existing supplier's motor?
   
If yes, please explain
    


Annual volume?

    

Target price?

    

Target productions date?

    
Customer part number?
    
Competitor part number?
    
Gear box type?
    
Motor type?
   


Rated voltage?
Check one:

    

Voltage range?
Check one:

   
Output torque est by?
Check one: Test/Calculation/Estimate
    
Starting torque
   
In-oz.?
    
In-ibz.?
    
Run torque
    
In-oz.?
    
In-ibz.?
    
RPM at no load?    
RPM at load?    
Will gearmotor be stalled?   


Ambient temperature?

    

Humidity level?

    

Altitude?

    
Full enclosure?
   
Degree of ventilation?
    
Corrosives?
    


<25%/25%/50&/75%/Continues/Other

    
If Otheer,please define:
    
Standard duty cycle:
    
ON (sec/min/hrs)?    
OFF (sec/min/hrs)?    
Minimum life required:
cycles.hrs? 		   
For reversing applications, what is
minimum time off between reversals?		    


Rated voltage ?
   
Frequency : HZ?    


Shaft OD/shaft detail?
    
Direction of ration?   
Viewed from?   
Extension from mounting surface?   


Mounting position?
   
horisontal/output down /output up   
Agency requirements (please list)
UL/CS A/CE/Other?		   
We have a:   
drawing /set/performance curve/
sample motor/set/other?		        other :