First Name
Last Name
Company Name
Address
City
State ---AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaVirgin IslandsWashingtonWest VirginiaWisconsinWyoming
Zipcode
Company Type DistributorWholesalerManufacturerConsumerOther
If you chose "Other" as Company Type, please explain
Email (required)
Phone Number (required)
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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