First Name
Last Name
Company Name
Address
City
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Company Type DistributorWholesalerManufacturerConsumerOther
If you chose "Other" as Company Type, please explain
Email (required)
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Fax Number
Brush Quantities Needed
Brush Application
A. Length of Brush Face (inches)
B. Overall Length of Shaft (inches)
C. Shaft Extension -Left- (inches)
D. Shaft Extension -Right- (inches)
E. Shaft Diameter -Left- (inches)
F. Shaft Diameter -Right- (inches)
G. Brush Diameter (inches)
H. Shaft Material ---AluminumStainless SteelSteelOther
– If "Other" is selected, please indicate type
I. Keyway
– Length (inches)
– Width (inches)
– Depth (inches)
J. Brush Channel Size ---#7 W=.320 (inches) H=.340 (inches)#4 W=.194 (inches) H=.196 (inches)#3 W=.143 (inches) H=.158 (inches)
K. Filament Type ---NylonPolypropylenePolyesterTampicoHorse HairBrassPhosphorous BronzeStainless SteelCarbon SteelOther
L. Lead
M. Left or Right Hand Wound
Additional Information
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