Hose Assembly Quote Request | Southeastern Hose


	Hose Assembly

Request for Quote: Hose Assembly

Hose Assembly Specification Form
*Indicates required fields
To fax this form:
Please print, complete, and fax to 770-537-5573.

To help us better assist you and to ensure a timely response, please supply us with the most complete and accurate information. Please see "special requirements and additional information" to list any items not shown on this form.

*Company
*Contact
*E-mail
Phone
Fax
Project
Inquiry No.
Quantity
Date Required
Item/Style
Size
I.D.	(in.)
O.D.	(in.)
Overall Length (OAL)	(in.)
Pressure
Working	(psi)
Test	(psi)
Other	(psi)
External	(psi)
.	Atmospheric
Pressure Type	Constant Shock Pulsating Intermittent
*Define
Temperature
Operating	(°F.)
Design	(°F.)
Media
Internal Flow Media
External Environment Corrosives
Hose Material
Braid Material
Braid Layers	0 1 2
Application
Motion
Lateral (Either Side of Center Line)
Angular (Either Side of Center Line)
Motion Frequency
Cycles Per
Velocity	(ft./sec.)
Hose Assembly Configuration	Straight *Dogleg Jacketed/Duplex
*Define Lengths
Liner Material (if required)
Cover Material (if required)
End Fittings
Fitting #1
Size
Type
Material
Fitting #2
Size
Type
Material
Pipe Schedule, Wall Thickness, or Pressure Rating

Special Requirements or Additional Information

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