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HBD INDUSTRIES / THERMOID
Industrial Hose Inquiry Form
SIZE
ID (in.)
OD (in.)
Hose Length (ft.)
    Overall Assembly Length (OAL)?       Uncoupled Length?
 
Tolerances (+/-)
    ID (in.)
     OD (in.)
     Hose Length (ft.)
       
TEMPERATURE
Of Material being conveyed
    High
   Low
   Ambient
 
Of outside exposure
    High
     Low
     Ambient
Intermittent?
  Y/N    
Constant?
  Y/N    
Sub-Zero Exposure?
  Y/N    
       
APPLICATION(S)
Location of Use  
Indoors   Outdoors   Both
Periods of Use (hrs./week)
    Intermittent       Continuous
Flexibility
(Min. Bend Radius; in.)
Weight of Hose
(lbs./100 ft.)
Movement?  
Static   Vibrations   Flexing
 
External Conditions
Abrasion   
Acid   
Oil   
Ozone
Solvents   
Electrical/Static Conductive
 
RMA Oil Resistance
   for Tube
    for Cover
 
Flame Resistance
Non-Contaminating Materials?
  Y/N    
Adverse Conditions
 
MATERIAL(S) BEING CONVEYED
Solids (size; description)
Gaseous (volatility; inert)
Liquids
(flammability; causticity)
Liquids (pH; acid/alkaline)
Liquids (% solution/conc.)
Chemical Names (generic)
 
REQUIRED APPROVALS
Electrical
 UL
Food Handling
 FDA
Mining Safety
 MSHA
Environment
 CGA   CARB
Other (please specify)
 
PRESSURE
Working Pressure
Working Pressure (psi, at surge)
Burst Pressure (psi)
Suction/Vacuum (In. Hg)
     Suction    Vacuum
Flow/Velocity (gpm)
Impulse
 
ENDS & FITTINGS


Factory-Applied Fittings
  
Thread Type
 Male
 Female
 Reusable
 Non-Reusable
 


Built-In Fittings & Ends
  
Materials for Fittings
 Beaded
 Flanged
 Rubber Lined
 Other
 Cut to Length
 


Crimp Specifications
  
ATTACHMENTS
  ' '   ' '
       
DELIVERY
Req. Date (mm/dd/yy)
Annual Quantity
    feet       standard length/reels
Typical Order Quantity
    feet       standard length/reels
Special Print/Labeling
Special Packaging
 
OTHER INFORMATION
Contact Name
Contact's Telephone
Contact's Fax
Contact's Email
Customer Company Name
Customer Number
Ship To
Bill To
Hose Currently in Use
Current Hose Service Life
Failure Description
Service Life Desired