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Hose Internal Bore Size mm
Hose Overall Length meters
Hose Working Pressure PSI
Suction Application? Yes   No
Discharge Only Application ? Yes   No
Flange Pattern Required (if Applicable)
(Table D,E, Ansi 150 etc)
Material to be conveyed
Temperature of Material
External Conditions
(How will hose be used)
Any other Relevant Information
Contact Name
Company
Company Address
Phone

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