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Customer PO# / Reference# *
Contact Name *
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Shipping Country *
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Company *
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Acct # *
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Hose Material *
Hose Pressure Level *
Hose Type *
Fluid Medium *
Hose Size *
Fire-Sleeve / Sleeving (if applicable)
Hose Style Configuration *
Clocking Angle (Assemblies with 2 Elbows Fitting *
Length In Inches (Round up to nearest 1/8) *
(Note: All hoses measurements must be sealing surface to sealing surface) (**Verify with Hose Specialist for minimum length)
Qty *
Special Requirements (Fees may apply): (FAA 8130-3, Pressure Tests, Materials Certs, etc.
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