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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

Contact Person
Position
Phone
Fax

APPLICATION DETAILS

Do you have a project name?
Will you require the APM Hexseal product to be in compliance with any particular specification(s)?If so, please provide them.
0 /
Will you need a Chemical & Physical Analysis report?
If you already know the APM Hexseal part number, please enter it here

BOOTS & SEALS

Please help us determine the best part for your application by answering as many of the following questions as possible.

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?
0 /
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?
0 /

Other

Please explain what you are looking for in as much detail as possible.
0 /

Additional Information

Any additional information you think is important for us to know?
0 /
Number of sample pieces you would like?
Date your would like your samples?

*Please be aware that all Sample Requests are subject to part availability.

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