Name:
Title:
Company:
Street Address:
Street Address (cont.):
City:
State/Province:
Zip/Postal Code:
Country:
Phone:
Fax:
E-mail:
Industry:
Your Company is a:	OEM  End User  Distributor  Other
Your Need is:	Immediate  Within 3 months  Over 3 month
Application Type:	Single Drive (Traveling Column)  Dual Drive (Traveling Gantry)
Application Description:
Operating Environment:
Axis Orientation:	Horizontal  Vertical  Other
Positioning Accuracy:	inches
Backlash Required:	Low  Zero  I'm Not Sure
Axis Weight:	lb.
Axis Travel Length:	feet
Axis Supports:	Linear Guides  Rollers  Other
Maximum Axis Speed:	inches per minute
Acceleration Time/Rate:	seconds  or:  inches/sec2  or:  G
Additional Axis Forces:	lb.
Lubrication:	Grease (Recommended)  Oil  Not Sure  None
Operating Time:	Intermittent  < 8 hours/day  < 16 hours/day  24 hours/day
Load Factor:	Uniform Load  Moderate Shock  Heavy Shock
Motor Selected (if any):
Motor Speed:	rpm
Nominal Motor Torque:	in.lb.