HOLD-N-DRIVE QUOTE REQUEST FORM #2A Page 1 of 2 Date _________________________
PLEASE COMPLETE BOTH SIDES Name ________________________________________________________________ Phone ________________________________Fax ___________________________ Company _____________________________________________________________
1886 Larchwood Dr. Troy, MI 48083 Fax (248) 526-0019 (248) 589-8100
Address ______________________________________________________________ City _________________________ State ______________ Zip ________________ Country ______________________________________________________________
Dimensions - Give Maximum Allowable
Dimensions - Give Maximum Allowable
A:
_______ IN
_______ MM
A2:
______IN
______MM
B:
_______ IN
_______ MM
B2:
______IN
______MM
C:
_______ IN
_______ MM
Hex Size:
______IN
______MM
D:
_______ IN
_______ MM
Hex:
______ 6PT ______12PT _____ Other
Hex Extended?
______IN
Hold Bit:
______Hex ______Other
Bit Travel:
______IN
E Std: Size dependent on power tool selected E Optional Extension: ____ IN ____ MM If necessary, can a sample of the part be sent for our review? ______Yes ______ No
Torque Output Requirement: (Fill in one only) Fastener Torque Requirement _________Inch/lb. _________Foot/lb. Is This Fastener Application _______Hard Joint _______Med Joint
Š Copyright 2000
______MM
______MM
_________NM _________KG/CM _______Soft Joint
Jemms-Cascade, Inc. 1886 Larchwood Dr., Troy, MI 48083 USA (248) 526-8100 Fax (248) 526-0019