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	:: CONTACT US :: Company Name: Mech Tex Manufacturing Company Pvt. Ltd.  Address: A-1 Minerva Industrial Estate Mulund (W),                   Mumbai - 400 080, Maharashtra (India). Tel: +91-22-25652276 Fax: +91-22-25686315 E-mail: info@mechtex.com

:: SALES APPLICATION FORM :: Organization/Company Name: Your Name: Your E-Mail: Phone:    (Include Country/Area Code) Fax:    (Include Country/ Area Code) Street Address: City/State: Zip/Postal Code: Country: Application Customer Application What mechanism motor will drive ? Is the application new ? Yes No Who is the current Supplier ? Is the Unit Available for Testing ? Yes No Problem with the current Supplier  Ratings Rated Voltage  Voltage Range Frequency (Hz) Start Torque Run Torque RPM at Load Will the gearmotor be stalled ? Yes No Ambient Condition Ambient Temperature Humidity Level Full Enclosure Yes No Degree of Ventilation Corrosives Any other Parameter in the application ? Duty Cycle / Life  Duty Cycle < 25 25% to 50% 50% to 75% 75% to 100%Continuous Standard Duty Cycle (ON) mm:ss Standard Duty Cycle (OFF) mm:ss Most Demanding (ON) mm:ss Most Demanding (OFF) mm:ss Minimum Life Required  Cycles Minimum Life Required  Hours Time between Reverse Application (If Any) mm:ss Clutch Requirements Clutch Required ? Yes No Feedback / Limit Switch Requirements Overhung Load  Yes No How Much ? gms Distance from Mounting Surface mm Axial Thrust Load Yes No How Much ? gms Push In Push OutBoth Output Shaft Requirements Shaft OD mm Direction of Rotation Clock-wise  Counter Clock-wise Above Direction of Rotation when Viewed From Cover Side Motor Side Shaft Details Flat TongueWoodruff Hole Keyway Slot Extension from Mounting Surface  (Cover Side) mm Extension from Mounting Surface (Motor Side)  mm   Agency Requirements  UL CE  Any Other Requirements Sound / Vibration Requirements Method Of Testing   Gear Box Selection Particular Gearbox from  Mechtex Mechtex Recommended Comments  Any Special Approvals  Mounting Position

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