Brake Request Form


Please fill out as much as possible.


Specifications:


What type of brake would you like:    Quantity:


Would you like the brake to be failsafe (spring applied)?    Failsafe:   Non-Failsafe:

Braking Torque Required: (Without safety factor applied to value, please specify ft.lb. or Nm)



What is the brake going to be used for ?
Stopping (Dynamic) Emergency Brake Tensioning Brake

Estimated number of stops per 24 hour period:


What type of power would you like to control the brake?
Air Hydraulic Electric Manual

If you chose Electric, what is the Power Voltage:



Control package required:      

Power Unit, Power Voltage:     Control Voltage:



Maximum Disc/Drum Diameter allowable: (Please specify in. or mm)

Please check the following items,

Disc/Drum required:   Drum:   Disc:

Keyed hub:   Standard Bore:   Tapered Bore:   Dynamically Balanced:   Spigot:   Mounting Holes:

Bolt circle diameter:(Specify in. or mm)

Brief Description of your application:



Required Information:

Company name:

Address:

City:

State/Province/Territory:

Country:

Postal/Zip Code:

Tel.:

Fax.:

E-mail Address:

Web site:

Contact Person:


Please Press or

Thank you for your interest in our products...