Customer Information
 
Please fill out the required End User information below
 
 
 
End User Company Name*
 
 
 
 
 
 
End User Site Location (final destination of the actuator):
 
 
 
 
Street Address*
 
 
City*
 
 
 
 
 
 
State/Province
 
 
Country*
 
 
 
 
 
Application Information
 
 
 
Industry Information*
 
 
 
 
 
 
Application (What process is the valve controlling?)*
 
 
 
 
 
 
Max. required thrust (linear-lbf) or torque (rotarty-lbin)*
 
 
Stroke length (inches) / rotation (degree)*
 
 
 
 
 
 
Normal modulating stroke speed requirement (if any)*
 
 
Mechanical fail-safe speed requirement (if any)*
 
 
 
 
 
Control Signal (i.e., 4-20 mA, Hart, FF)*
 
 
Main electrical power supplies available at site*
 
 
 
 
 
Cable connections (quick connect or flying lead)*
 
 
Cable length between actuator and enclosure*
 
 
 
 
 
 
Hazardous Area Classification Requirement (if any):
 
 
 
 
Actuator*
 
 
Control enclosure*
 
 
 
 
 
 
 
 
Valve Information
 
 
 
 
If linear valve:
If rotary valve:
 
 
 
Plug type*
 
 
Break torque (lb-in)*
 
 
 
 
 
 
Flow direction*
 
 
Seat torque (lb-in)*
 
 
 
 
 
 
Max differential pressure or shutoff pressure (psi)*
 
 
Max dynamic torque (lb-in)*
 
 
 
 
 
 
Is valve mounting adaption hardware required?*
 
Yes
No
 
 
 
 
 
If yes, please supply valve manufacturer make, model and size.*
 
 
 
 
 
Will the valve be shipped to REXA for mounting and calibration?*
 
Yes
No
 
 
 
 
 
 
 
Your Information
 
 
 
First Name*
 
 
Last Name*
 
 
 
 
 
 
Company Name*
 
 
Job Title*
 
 
 
 
 
 
Email*
 
 
Phone*