Breaker Plate Quote WorksheetIf you prefer to print and fax this form, click here for PDF. Please enable JavaScript in your browser to complete this form.Company Name *Contact Name *Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Email *Please provide the following information so we can determine the extrusion tooling that best suits your needs.Please provide the following information so we can determine the extrusion tooling that best suits your needs.Extruder Make:Extruder Model:Material:420 Stainless SteelC-276 HastelloyOther (Please Specify Below)Other:Choose Style:ABCDERefer to STANDARD BREAKER PLATE DRAWINGSApplication:PressureJacketing / SleevingTube ExtrusionOther (Please Specify Below)What type of product will this breaker plate be used to make?Other: Total Number of Holes:Hole Size:Dimensions (please specify separately if more than one size required): Refer to BREAKER PLATE DRAWING STYLE A, B, C, D, OR ELarge OD (X):Small OD (Z):Width (Y):Reference Print Click or drag a file to this area to upload. Specify quantities requested and any special instructions:Submit
