Tell us about your application

Fill out and submit the form below or print and fax it to Kerk Motions, Inc. 1.603.465.3598

Application Data Sheet

*Customer:

*Contact:

*Address 1:

Address 2:

*City:

*State:

*Country:

*Zip/Postal Code:

*Work Phone:

Work Fax:

*E-Mail:

*Date:

Type of Application/Description:

*Anti-backlash nut system required?:

Yes

*Screw mounted?:

Vertically

Horizontally

Length:
Diameter		Lead (advance/rev.)

Standard lead accuracy (.0006 in./in.)

High lead accuracy=

End machining required?:

Yes (attach detail drawing)

Kerkote® TFE coating?

Approximate RPM:

Model/series (if known)		Traverse speed:
Approximate dynamic loading Axially:		Radially:

Usage:

Light duty

Intermittent

Continuous

Any special environmental conditions (temperature, dirt, abrasives, space limitations, etc.)?

New Requirement?

Yes

Or presently using

Initial quantity?

Annual usage

# of years

Quotation required?

Yes

Quantity (s)

Other/notes: