Contact Information
First Name	Last Name	Title

Company

Division

Street Address

Suite/Mail Stop/Dept.

P.O. Box

City

State/Province

Zip/Postal Code

Country

Phone

Extension

Fax

E-Mail

Application Data

Please provide as much information as possible. If any data is unknown or questionable, please note in COMMENTS if a Comptrol representative should contact you to discuss your application.

Type of Application

Max. Operating Load (lbs.)

Attitude Horizontal Vertical Incline deg

Type of Ways Supporting Load Box Dovetail Ball Bushing     Other (specify)

Max. Velocity (in./sec.)

Positioning Accuracy Required

Max. Allowable Backlash (specify in. or mm.)

Total Travel/Cycle (specify in. or mm.)

Design Life Objective (specify in. or mm.)

Type of Lubrication

Ballscrew Diameter (specify in. or mm.)

Lead (specify in. or mm.)

Thread Length (specify in. or mm.)

Ballnut Configuration Non-Preloaded Preloaded

Ballnut Mounting Base Flange Cut-Off Flange Trunnion

End Support Mounting (Drive End) Base Flange Cut-Off Flange

End Support Mounting (Trail End) Base Flange Cut-Off Flange

End Support Fixity (Drive End-Trail End) Rigid-Free Rigid-Simple Rigid-Rigid Simple-Free Simple-Simple Simple-Rigid

Comptrol to specify & supply motor and drive Yes No
If no, please specify motor/drive manufacturer	Motor Model No.	Drive Model No.
Comptrol to specify & supply control Yes No
If no, please specify control manufacturer	Model No.
Installation: New   Existing

Information Requested: Sizing & Selection Only   Sizing, Selection, and Quotation

Comments: