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.)

Motor Mounting Configuration Parallel In-Line

Positioner Mounting Configuration Base Feet Clevis Trunnion

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	Control Model No.
Options (Select all that apply) Home & Overtravel Sensor Kit Encoder Brake

Installation: New   Existing
Information Requested: Sizing & Selection Only   Sizing, Selection, and Quotation
Comments: