Initiated by:

    Date:

    Quote needed by:

    NOTE: IT IS IMPERATIVE THAT ALL THE INFORMATION ON THIS FORM IS PROVIDED FOR US TO DESIGN A CUSTOM SPACER TO EFFECTIVELY MEET YOUR NEEDS, AND ALSO TO PROVIDE YOU WITH AN ACCURATE QUOTATION

    Customer Information

    Company

    Address

    City

    State

    ZIP Code

    Contact Name*

    Title

    Telephone*

    Fax Number

    Email Address*

    Casing Information

    Length of casing run

    Quantity of spacers needed

    Casing inside diameter

    Casing wall thickness

    Spacer centers in bore

    What is casing going under?

    Casing outside diameter

    Casing material

    Duct Information

    NOTE: THIS FORM ACCOMMODATES SPACERS REQUIRING UP TO 4 DIFFERENT DUCT SIZES / TYPES. FOR GREATER NUMBERS, PLEASE CONTACT FORMEX MANUFACTURING.

    Duct Size 1

    Duct size (nominal)

    Type of duct/material

    Number of each duct size

    Duct Size 2

    Duct size (nominal)

    Type of duct/material

    Number of each duct size

    Duct Size 3

    Duct size (nominal)

    Type of duct/material

    Number of each duct size

    Duct Size 4

    Duct size (nominal)

    Type of duct/material

    Number of each duct size

    Minimum Dimensions

    NOTE: IF YOU DO NOT SPECIFY MINIMUMS, AS SOME CUSTOMERS DO NOT, WE WILL USE OUR STANDARD MINIMUM SEPARATIONS.

    MINIMUM REQUIRED DIMENSIONS DUCT OD - DUCT OD

    MINIMUM REQUIRED DIMENSIONS DUCT OD - SPACER OD

    MINIMUM REQUIRED DIMENSIONS DUCT OD - CASING ID

    MINIMUM REQUIRED DIMENSIONS SPACER OD - CASING ID

    Will the casing be filled? YESNO

    What will the fill material be?

    Does the spacer require an opening for a fill hose? YESNO

    If yes, what is MIN DIA?

    Is the application for communications, power, both, or other?
    CommunicationsPowerBothOther

    Should the spacer be quoted with optional low profile caster assemblies? YESNO

    Other pertinent information: