(Table D,E, Ansi 150 etc)
(How will hose be used)
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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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