Date* MM slash DD slash YYYY Company* Point of Contact* First Last Email* Phone*Fax1. LOAD REQUIREMENTSMeasurement Capacity QuantityType of Loading Static Fatigue Impact One Way Fully Reversed Capacity Overload Requirements: 150% without zero shift (standard) 300% without structural damage (standard) Other Describe Bridge Loading Configuration: Single-Axis Bi-axial, Two Axes at 90° Apart Redundant (dual) Bridge 2. CLEVIS PIN CONFIGURATION AND LAYOUT Clevis Pin Clevis Bolt Thread Size Ae: Width of Clevis Eye Tol: Bc: Width of Clevis Cheeks Tol: Db: Diam. of Clevis/Eye Bore Tol: Dp: Diam. of Clevis Pin/Bolt Tol: Ec: Width of Clevis Tol: 3. DESIGN FEATURESSpecify Connector Type Connector Permanently Attached Cable Length Specify Connector/Cable Location (1-5) Load Direction Standard Loading is applied through the clevis eye and perpendicular to the keeper slot. (See "Standard" load direction below.) Standard Other * Please email any sketches or mark-up copy of this printed form to indicate load direction and keeper slot location to the attention of Rob Turzanski or fax to 610.825.1734. Please be sure to include your pertinent contact information and reference this questionnaire.4. ENVIRONMENTAL REQUIREMENTS Indoor Outdoor Submerged Pressure Operating Temperature 5. ELECTRICAL REQUIREMENTSPin Output: mv/V (standard) 4-20ma loop powered Other Describe 6. SPECIAL / INSTRUMENTATION / CLEARANCE REQUIREMENTSPlease enter any pertinent information below:NameThis field is for validation purposes and should be left unchanged. Δ
