Date:

Time:

Sales Engineer:

Organization:

Phone Number:

Fax Number:

Email Address:

Return Quote to Rep?:

YesNo

Return Quote to Customer?:

YesNo

Company Name:

Contact Name:

Title:

Address:

City:

State:

Zip Code:

Telephone:

Fax Number:

Email Address:

Competition Quoting?:

YesNo

If Yes, Who?:

How Competitive?:

Extremely
Close (10%)
Not an Issue

Probability of Getting Order?:

100%
75%
50%
25%
Less

Quoted Previously?:

YesNo

What is Drawing/Quote Number?:

Application/Project Name:

Estimated Purchase Date?:

Quantity to be Quoted:

How to Quote?:

Bulk
As Kit (Cut,Drill,Tapped)
Full-Assembled
Both

Return Quotation By?:

Rolling BearingBall-Screw

Stroke Length:

Length of Carriage:

Load Weight:

Position of Load? (Indicate on Drawing/Sketch):

Actuation Method:

Positioning Tolerance Requested?:

YesNo

How will Sub-Assembly Be Used?:

Need Frame?:

YesNo

Need Enclosure/Guard?:

YesNo