	Valve Quotations Questionnaire

	Pneumatic Actuators Quotations Questionnaire

	Electric Actuators Quotations Questionnaire

Electric Actuators Quotations Questionnaire

Please complete the form in its entirety and click SUBMIT. It will be directed to our Customer Service department.

Contact Information

Date:
Date Required:
Contact:
Address:
City:
State:
Zip:
Phone:
Fax:
Email:
End User (or ID No.):
Is this quote for project:		estimate or purchase?
If a purchase, when will purchase be made?
Who is your DynaQuip Controls distributor?

Electric Actuators Information

1. What voltage is desired? AC DC

2. NEMA Rating Required

3. Is a special duty rating required (25% duty is standard)?

4. Are there special cycle time requirements (speed)?

5. How often will the valve be cycled (cycles per hour or day)?

Cycle Per Hour

Cycle Per Day

6. Will actuator be required to operate 24 hours a day?

Yes No

7. Is a manual override required?

Yes No

8. Are extra auxiliary limit switches required?

Yes No

9. Are there special requirements