Please complete the form below and one of our representatives will contact you shortly. Name: Title: Company Name: Address: Address: City: State: Postal Code: Country: Application Information Telephone: Mobile: Fax: Email: Website: EAU: Drawing/Part#: Description of application: Mechanism driven by output shaft: New or existing Is the unit available for test If existing, who is the current supplier: Yes No Any problems or concerns with current supplier? Currently in production?: Yes No Performance Requirements Voltage: Voltage range: If no, estimated time to production: Current limitations: Output Torque determined by: Start torque Run torque: No load output speed: Environmental Conditions Ambient temperature: Full enclosure: RPM degrees Output speed under load: RPM Humidity level: Corrosives: Other information about the motor location: Duty Cycle Maximum run time: Number of cycles per hour: Minimum time off: Minimum life required (cycles or hours): For reversing applications, the minimum time between reversals is: Output Shaft Requirements Shaft OD: Shaft extension from mounting surface: Shaft detail: Cover side: Shaft material: Case (or motor) side: Overhung load? Yes No Describe: Axial Thrust Load? Yes No Describe: Power Supply Maximum current limit? Type of power supply: Voltage rating: Frequency: Feedback and Noise Considerations Tachometer Encoder DC Tach Hall effect Optical VDC/kRPM AC Tach: Single or dual channel? Is the supply filtered? Yes No kHz Pulses/Rev PPR Are there audible/vibration requirements? EMI / RFI Emissions type: Enclosure type: