Customer Name:
Date:
Address:
City:
State, Zip:
Phone:
Fax:
E-Mail:
Customer Contact Name:
Quantity:
SHEAVE INFORMATION
Sheave Diameter:
Wire Rope Size:
Number of Sheaves:
BEARING TYPE
Bronze Bushing
Roller Bearing
Tapered Roller Bearing
Other
BLOCK INFORMATION
Style:
Vertical
Horizontal
Dimensions: A:
B:
C:
D:
APPLICATION INFORMATION
Line Speed:
Single Line Pull:
Degree of Wrap:
Environment:
FREQUENCY OF USE
Continuous
Intermittent
One Time
SPECIAL REQUIREMENTS
Special Testing:
Finish:
Third Party Inspection/Approval:
(If 3rd Party Inspection or Approval is required, please refer to page
359
.)
