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Contact & Mailing Information

Company Name

DOMESTIC (US)

Address
Address 2
City
Zip/Postal Code

INTERNATIONAL

Address
Address 2
City
State or Province
Zip/Post Code

Contact Details

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Position
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APPLICATION DETAILS

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Will require the APM Hexseal product to be in compliance with any particular specification(s)?If so, please provide them
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BOOTS & SEALS

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If "Other" Please specify
Manufacturer of switch/device?
Manufacturer’s part number for switch/device?
Is there a Drawing or Cut Sheet available?If yes, you will receive instructions on how to submit drawings after your request is received and processed.
Threads?
Mounting hold dimensions?
Do you have specific environmental concerns?
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If "Other" please specify
Rubber Color

HARDWARE

If you are unsure of a specific part number, please help us determine what you need for your application byanswering as many of the following questions as possible.

Screws & Bolts

Threads
Length
Clearance hold dimensions?

Nuts

Threads?
Nut Material?
Sealing Material?
Clearance hold dimensions?

Washers

Diameter of hole being sealed?
Thread size of fastener being used?
Outer diameter?
Sealing Material?
Any additional information you think would be important?
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Other

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Additional Information

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Number Of Units For This Order
Projected Annual Requirement
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