FULL NAME *

EMAIL ADDRESS *

COMPANY NAME *

ADDRESS *

CITY *

STATE *
Please SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingDistrict of ColumbiaPuerto RicoGuamAmerican SamoaU.S. Virgin IslandsNorthern Mariana Islands

ZIP *

TELEPHONE *

3. Dimension Standards
InchMetric

4. Metal Core Diameter *

5. Finish Rubber Diameter *

6. Metal Face Length *

7. Rubber face Length (if different from metal)

8. Specify Step Down if Necessary
To MetalStep Down To Rubber

9. Step Down Measurement * (Length X Depth)

10. Overall Roll Length * (W/ Journals)

11. Rubber Coating Hardness
15A40A70A100A20A50A80A60A30A60A90D70DOther

12. If other, Specify

13. Rubber Coating Type
NeopreneBUTYLEPDMNATURALBUNA­ N/NitrileHYPALONCARBOXILATED NITRILEURETHANESILICONEVITON (fluoroelastomer )SBRFLUORO­SILICONEEPDM/SILICONE BLEND

14. Color (If Not Black)
GreenBlueOrangeTan

15. Special Grooving Needed
YesNo

16. If Yes, Specifiy Type
CHEVRONDIAMONDHERRINGBONEPARABOLIC (CONCAVE)SPIRALCROWN (CONVEX)STEP & PLUNGETAPERED ENDSRULINGDOUBLE TAPERSPREADERFULL TAPER

18. Quanity *