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Motor Request Form

Customer Information

Attention:
Today’s Date:
Customer:
 
Type of Business
Status:
Address:
 
City:
 
State:
 

Zip:
 

Sample Information

   
Customer No:
Sales Engineer:
 
Customer P.O. No:
Sample Quantity:
Date Required:
Customer Part No:
1st Order Quantity:
Date Required:
Sales Order No:
Annual Quantity:
Date Required:
Motor Part No:
Sample Price:
 
Ind. Code:
Market Price:
 
Market Code:
Billing:
 
CSR:
Tool to be Paid By:
Ship Via:
Competitor:
Ref. Motor Part No:
Rev:
Probability of Success:
Competitor Part No:
 
Electrical Description:
Except as Noted:
 

MOTOR SPECIFICATIONS

   
Application:
Thickness Gauge:
 
 
Motor Type:
Shaft End Play:
Min:
 
Max:
 
Speed(s) (RPM):
Shaft Rotation Lead End:
 
Full Load Torque (OZ IN):
Front Shaft Position:
 
Lock Shaft Min. Torque (OZ IN):
 
Shaft Material:
 
 
Voltage Range: 
Min. to Start:

Min. to Accel:
Shaft Diameter:
 
Expected Motor Life (Duty):
Front Shaft Extension:
 
Temperature Rise Limit:
 
Back Shaft Extension:
 
Enclosure:
Water Slinger:
 
 
Specifications:  
 Volts:

 Hertz:

 HP:

 Phase:
Shaft Special Treatment:
 
  Type:
Motor Protection:
 
Motor Mounting Means:
 
 
Agency Recognition:
 
Re-Oiling Provisions:
 
 
Relay / Starter:
(Type Location)
 
Grease or Oil Type:
 
 
Preferred Capacitance: (Locations)
Bearings:
 
 
MFD at how many Volts?
Conduit Box and Location:
 
 
Thermo-couplers:
Motor Finish: 
Color: 
 
Type:
 
 
Wire Color Code:
 
Motor Length Limitations:
 
 
Lead Wire Material:
 
Noise Level Critical: