Company*           Date     
                                    
                                    Address*           Ref.       
                                    
                                    City / State*      Rep.     
                                    
                                    Contact            Phone #* 
                                    
                                    Title              FAX #    
                                    
                                    
                                    APPLICATION  (driven equipment):  
                                                                     
                                    
                                    Duty Cycle   hours/day      Input Speed
                                      RPM      Output Speed   RPM
                                    
                                    
                                    PRIME MOVER:
                                    
                                      Electric Motor:
                                    
                                          Size   HP          Speed   RPM        Soft Start  
                                    
                                         Frame         NEMA Design           AC  
                                        DC  
                                    
                                    Variable Speed:
                                    
                                       Minimum   RPM       maximum   RPM     AC       DC   
                                    
                                    Preferred Mounting:
                                    
                                                 Foot                Flange
                                    
                                    
                                    Engine:
                                    
                                          Size   HP          Speed   RPM
                                    
                                          Type           No. of Cylinders  
                                    
                                    Hydraulic Motor:
                                    
                                               Size   HP     Speed   RPM
                                    
                                    SAE Size & Type  
                                    
                                    LOAD PROFILE:
                                    
                                     Normal Running Load:   Lb. -
                                    In.    Duration  
                                    
                                           Starting Load:   Lb. - In. 
                                     Frequency      Duration  
                                    
                                               Overloads:   Lb. - In.   Frequency
                                         Duration  
                                    
                                          Reversing Load:       Frequency  
                                    
                                          Impact Loading:       Frequency  
                                    
                                         Brake In System:            Type      Capacity   Ft. - Lbs.
                                    
                                                Location:  
                                    																	
                                    OVERHUNG LOAD:
                                    
                                    Input Shaft:    
                                    
                                                     Type       Pitch Diameter
                                      in.
                                    
                                        Position On Shaft  
                                    	
                                    Output Shaft:
                                    
                                                 Sprocket              Pinion  
                                    
                                           No. of Strands      Pitch Diameter   In.    Face Width   In.
                                    	
                                        Position on Shaft  
                                    																				   
                                    POWER FLOW:
                                    
                                             Concentric Shaft      Parallel Shaft  
                                    
                                                Off-set Shaft         Right Angle  
                                    
                                      Input Shaft: Horizontal            Vertical
                                        Up      Down     Slope Angle  
                                    
                                     Output Shaft: Horizontal            Vertical
                                        Up      Down  
                                    
                                     Input Shaft Rotation: CW                 CCW   (looking at input shaft)
                                    
                                    ENVIRONMENT:
                                    
                                    Ambient Temperature:
                                    
                                            Maximum    Degrees F     Minimum    Degrees F
                                    
                                    Location:
                                    
                                             Indoors     Outdoors       Enclosed (Poor Circulation)  																				   
                                    
                                    Direct Sunlight      Washdown                       Dusty/Dirty  
                                    
                                    ACCESSORIES:
                                    
                                               Input Shaft Coupling       
                                         Output Shaft Coupling  
                                    
                                      Motor Adapter (flanged motor)        Motor
                                    Bracket (foot motor)  
                                    
                                                           Bedplate          Motor Mount (belt
                                    drive)  
                                    
                                    SPECIAL SHAFTS (describe):
                                    
                                                Input  
                                    
                                               Output  
                                    
                                    MISCELLANEOUS:
                                    
                                    Identify any other factors which may influence the selection of a gear drive for
                                    this application:
                                    
                                    																			   
                                    
                                                    Delivery Required   Weeks
                                    
                                             Number of Units Required  
                                    
                                                          Destination