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Items marked with * are REQUIRED

Your Contact Info
Name*
Job Title/AOR
Company*
Address*
City*
State*
Zip*
Country*
Phone*
Fax
Email*
New or Existing product line to your company
Vehicle Info
Motor Application*
Vehicle Mfr.
Vehicle Model
Main Lift	Witd Auxiliary Witdout Auxiliary
Power Steering	Witd Auxiliary Witdout Auxiliary
Pump Info
No Load Pump	Torque		Ft. Lb. NM
	Torque		RPM
Full Load Pump	Torque		Ft. Lb. NM
	Torque		RPM
Relief Pump	Torque		Ft. Lb. NM
Pump Manufacturer
Pump Displacement			cu. in/rev. cu. cm/rev.
Minimum Speed			RPM
Maximum Speed			RPM
Maximum Pressure			PSI Bars
Battery Voltage (Volts)
Motor Requirements
H.P./K.W.*			HP KW
RPM*
Number of Terminals
Requested Rotation*	Clockwise Drive Endhead Counterclockwise Drive Endhead
Max Amps
Motor Voltage*
# motors per year*
# Prototypes*
Rating*	1 Hour Duty Cycle
	Continuous Duty Cycle
	5 min. Duty Cycle
	S2
	S3 %