Caltherm

Check Valve Questionnaire

 

Company Name: ___________________________________________    Address:_________________________________________________

Telephone/Fax:_____________________________________________

Company Contact:_________________________________________________

 

_____________________________________________________________

 

Application Description:

_____________________________________________________________

_____________________________________________________________

1.                 Application ______________________________________

 2.                 Cracking Pressure_________ PSI  or ________ KPA

 3.                 Flow _______ @ _________ PSI  or ________ KPA

 4.                 Maximum Leakage @ psid in reverse flow ____________

 5.                 Fluid Media _____________________________________

 6.                 Temperature range of system _______________________

 7.                 Duty Cycle/Durability __________________________

 8.                 Corrosive Factors ______________________________

 9.                 Mounting Method

Press Fit-Interference______ inches

Snap Ring ________

Other _________

 10.             Materials Required ________________________________

 11.             Estimated annual quantity _______________

 12.             Estimated target price ____________

Please copy and mail or fax completed questionnaire to Caltherm address below.

Caltherm Corporation

910 S Gladstone Ave

Columbus, IN 47201

(812) 372-0281 * FAX (812) 376-8305