Clamp-on Adapter Quote Worksheet

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Company Name:

Contact Name:

Street Address:

City: State: Zip:

Contact Phone: Contact Email:

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

Extruder Make / Size:

Extruder Model / Size

Note: Please email reference print if available.

Special Requirements:
Pressure Transducer Port Required
Port Orientation Requirements

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

Dimensions (please specify separately if more than one size required):
Refer to STANDARD BOLT-ON ADAPTER DRAWING

Adapter OD (X):

Centerline (Y)*:

Extruder Size (Z):

*Centerline (Y) dimension does not apply to in-line dies.

Specify quantities requested and any special instructions: