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Breaker Plate Quote Worksheet

If you prefer to print and fax this form, click here for PDF.

Company Name:

Contact Name:

Street Address:

City: State: Zip:

Contact Phone: Contact Email:

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Breaker PlatePlease provide the following information so we can
determine the extrusion tooling that best suits your needs.

Extruder Make:

Extruder Model:

Note: Please email reference print if available.

Material:
420 Stainless Steel
C-276 Hastelloy
Other (Specify)

Choose Style:
Refer to STANDARD BREAKER PLATE DRAWINGS
A
B
C
D
E

Application:
What type of product will this breaker plate be used to make?
Pressure
Jacketing / Sleeving
Tube Extrusion
Other (Specify)

Total Number of Holes:

Hole Size:

 

Dimensions (please specify separately if more than one size required):
Refer to BREAKER PLATE DRAWING STYLE A, B, C, D, OR E

Large OD (X):

Small OD (Z):

Width (Y):

Specify quantities requested and any special instructions: