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CONTACT INFORMATION

Name:

Telephone:

Company:

Fax:

Address:

e-mail:

City, State, Zip:

APPLICATION

POWER SOURCE

DRIVE SOURCE

Horsepower:

Pulley (No. of Grooves):

Model:

Pitch Diameters:

Manufacturer:

Chain (No. of Teeth):

Type:

Idle Speed:

Bearing Desired:

Loaded Speed (Max.):

Purpose of Clutch:

Loaded Speed (Min.):

Service:

Torque Required:

Other Comments:

Shaft Diameter:

Shaft Length:

MOUNTING

Clutch Series Desired:

Inboard/Outboard:

Prototypes Required:

Mounted On:

Quantity: