Tigerflex™ Products Custom Inquiry Form
Company Profile
Company Name ________________________________________________ Contact _________________________________ Address __________________________________ City ______________________ State ____________ Zip ______________ Phone _____________________________ Fax _______________________ E-mail ___________________________________ Application Details Application ______________________________________________________________________________________________ ___________________________________________________________________________________ Indoor ❏ Outdoor ❏ Material conveyed ______________________________________________________________ Solid ❏ Liquid ❏ Gas ❏ Type of fittings to be used _________________________________________________________________________________ Hose Construction Hose style: • Smooth profile (e.g. F series): ❏ • Convoluted profile (e.g. W series): ❏ • Externally reinforced (e.g. GT series): ❏ • Other: ❏ Describe _____________________________________________________________________________________ Similar to existing Tigerflex™ hose part number(s) (if applicable) ______________________________________________ Flex material ____________________________________ Flex color ____________________ Food Grade? Yes ❏ No ❏ Helix material ____________________________________ Helix color ___________________ Food Grade? Yes ❏ No ❏ Yarn reinforcement? Yes ❏ No ❏
Polyurethane liner? Yes ❏ No ❏
Grounding wire? Yes ❏ No ❏
Hose size(s) (ID) _________________________________________________________________________________________ Required working pressure __________ PSI @ 68º F
Required vacuum rating ____________in/g @ 68º F
Required bending radius ____________ in
Required hose weight _________________ lbs
Hose Length ________________________ ft
Tolerance +/-____________ in
Approvals required? _____________________________________________________________________________________ Other requirements ______________________________________________________________________________________ Delivery Information Estimated annual volume ______________________ Reoccurring? Yes ❏ No ❏
Required ship date _______________
Special packaging or shipping requirements _________________________________________________________________ Submit to: Fax: (847) 885-9010 • Email: customerservice@kuriyama.com • Submission date _______________________________
Because we continually examine ways to improve our products, we reserve the right to alter specifications or discontinue products without prior notice. KTFCA0519
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