REQUEST FOR HOSE FORM
Simply fill out the form below and submit.
* Required Field
Company Name
*First Name
Last Name
*E-mail
Phone Number
Hose ID
Please Select One
1/8"
3/16"
1/4"
5/16"
3/8"
1/2"
5/8"
3/4"
1"
1 1/4"
1 1/2"
2"
2 1/2"
3"
4"
5"
6"
8"
10"
12"
Other?
Hose OD (if applicable)
*Max Operating Temperature
°
F
°
C
*Length of Assembly
ft.
meters
Material Being Conveyed
Desired Working Pressure
or Vacuum
psi
bar
vacuum
Fitting Style End A
Please Select One
Male BSP
Female BSP
Male NPT
Female NPT
Male JIC
Female JIC Swivel
Sanitary Tri-Clamp
Sanitary I-Line Male
Sanitary I-Line Female
Sanitary Bevel Seat Male
Sanitary Bevel Seat Female
Other?
FItting Material End A
Please Select One
Aluminum
Brass
Stainless Steel 304
Stainless Steel 316
Ductile Iron
Carbon Steel
Plated Carbon Steel
Polypropylene
Nylon
PVDF
Teflon
Hasteloy
Other?
Fitting Style End B
Please Select One
Male BSP
Female BSP
Male NPT
Female NPT
Male JIC
Female JIC Swivel
Sanitary Tri-Clamp
Sanitary I-Line Male
Sanitary I-Line Female
Sanitary Bevel Seat Male
Sanitary Bevel Seat Female
Other?
Fitting Material End B
Please Select One
Aluminum
Brass
Stainless Steel 304
Stainless Steel 316
Ductile Iron
Carbon Steel
Plated Carbon Steel
Polypropylene
Nylon
PVDF
Teflon
Hasteloy
Other?
Preferred Method of Fitting Material
Please Select One
Band Clamps
Crimp Sleeve
Crimp Ferrules
Bolt Clamps SS
Bolt Clamps Galvenized
Other?
Quantity
Brief Description of Application