Design Request Form

We are always eager to assist you with any application design needs you may have. Please complete and submit the form below with your current data and a Polymer Concepts team member will contact you as soon as possible. Or if you prefer, you can also download a PDF version (100 KB) of the form and fax it to our office.

Basic Information

Name*

Title*

Company*

Address*

City*

State*

Zip code*

Phone*

Fax

Email*

* denotes a required field

Design Information

Product name

Application

Present seal

Number of seals/unit

Number of seals/year

Static

Reciprocating

Rotary

Oscillating

Rod seal

Piston seal

Inside face seal

Outside face seal

Stroke length

Life requirement

Strokes per minute

Friction required

RPM

Duty cycle

Oscillating degrees

Media/Fluid

Liquid

Gaseous

Pressure

Operating

Minimum

Maximum

Temperature

Operating

Minimum

Maximum

Glan O.D.

Material

Hardness

Finish

Glan width

Glan I.D.

Material

Hardness

Finish

Extrusion Gap

Can gland be modified? Yes No

Will seal be stretched? Yes No

Will seal pass by sharp edges? Yes No

Comments

To submit design drawings please attach them to an email.