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 Description:
Actuator Mounting Position:	Horizontal  Vertical  or:  degrees from horizontal
Actuator Style:	Rotating Spindle  Non-Rotating Spindle  Lifting Cylinder
Spindle Type:	Trapezoidal  Ballscrew  Not Sure
Axial Force on Spindle:	lb.  or:  N
Force Type:	Compressive  Tensile  Both
Stroke of Spindle:	mm  or:  inch
Linear Speed at Spindle:	mm/sec  or:  inch/sec
Self-Lock Required:	Yes  No  Don't Know
Persons Work Under Load:	Yes  No
Ambient Temperature:	ºC  or:  ºF
Typical Cycle Description:
Operating Time:	Cycles Per Hour Hours Per Day Days Per Year
Operating Environment:	Clean  Dirty  Outdoors  Other
Motor Selected (if any):
Motor Speed:	rpm
Nominal Motor Torque:	in.lb.