Clamp-On Adapter 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.Extruder MakeExtruder Model / SizeSpecial Requirements:Pressure Transducer Port RequiredPort Orientation RequirementsMaterial:420 Stainless SteelC-276 HastelloyOther (Please Specify Below)Other:Dimensions (please specify separately if more than one size required): Refer to STANDARD BOLT-ON ADAPTER DRAWINGAdapter OD (X):Centerline (Y)*:*Centerline (Y) dimension does not apply to in-line dies.Extruder Size (Z)Reference Print Click or drag a file to this area to upload. Specify quantities requested and any special instructions:Submit
