* Required Fields Please answer the following questions. Questions that do not apply may be left blank:

Customer Name:* Company:*
Address:* Address2:
City:* State:*
Zip:*
Country:
Phone:* Fax:
E-mail:*   Distributor Contact Person:
Type of Machine: Automatic Screw Machine
CNC
Manual (ie. Engine)

CNC
Manual (ie. Bridgeport)

C. Other

Type of Tooling:

(Select One or More)

A. High Speed Steel     B. Carbide
C. Coated (Describe )     D. Other

Type of Material: (Select One or More) A. Carbon Steel- Type
B. Stainless Steel - Type
Type
D. Brass- Type
E. Copper- Type
F. Magnesium- Type
G. High Alloys - Type
H. Cast Iron - Type
I. Other - Type
Operation:
(Select One or More)
A. Turning      B. Milling     C. Drilling     D. Grinding
E. Tapping     F. Sawing     G. Broaching    H. Other
Subsequent Operations:

Existing Operations

A. Cleaning

Alkaline Wash
Acid Wash
Water Wash
Solvent Wash
Vapor Degrease

 

B. Coating

Plating
Phosphate
Paint
Rust Preventative

 

C. Heat Treated or Annealed

After Cleaning
Without Cleaning

 

D. Welded

After Cleaning

Without Cleaning

 

E. Stored for length of time.

Desired Operations

A. Cleaning

Alkaline Wash
Acid Wash
Water Wash
Solvent Wash
Vapor Degrease

 

B. Coating

Plating
Phosphate
Paint
Rust Preventative

 

C. Heat Treated or Annealed

After Cleaning
Without Cleaning

 

D. Welded

After Cleaning

Without Cleaning

 

E. Stored for length of time.

Lubricant:

A. Existing Type of Lubricant:
Straight Oil
Water Soluble Oil
Synthetic
Semi-Synthetic
Vegetable Oil

Other

B. Desired Type of Lubricant:
Straight Oil
Water Soluble Oil
Synthetic

Semi-Synthetic
Vegetable Oil

Other

Method of Applying Lubricant: Existing Method:
Drip
Flood Normal
Mist
Other

Desired Method:
Drip
Flood

Normal
Mist
Other

Method of Monitoring Lubricant:

Existing Method:

None     
Concentration

pH     
Solids Content

Tramp Oil Content     
Water Content

Bacteria/Fungi/Yeast     
Rust Tests
Other

Desired Method:

None     
Concentration

pH     
Solids Content

Tramp Oil Content     
Water Content

Bacteria/Fungi/Yeast     
Rust Tests
Other

Method of Maintaining Lubricant:

None     
Bactericide/Fungicide Treatment

Antifoam     
Skimming

Decantation  
Filtration

Other

Special Considerations:

Chip Conveyor      
Inaccessible Reservoir

Centralized System
Excessive Tramp Oil

Reason(s) for Previous Lubricant Failure:

Rancidity     
Dermatitis

Price $
Availability (sump life= )

Transportation cost   
Rust Protection

Tool Life
Disposal Cost

My Primary Customer Concern Is:
 
 

  

 


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