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Crossheads and In-Line Dies 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. Email a product drawing if available.

Extruder Make:

Extruder Model / Size

Type of Polymer or Elastomer Extruded:

Type of Flange:
Clamp-on
Bolt-on

Largest Core OD or Tube ID:

Largest Finished OD:

Type:
Adjustable Center Crosshead
Fixed Center Crosshead
In-Line Die
Other (Specify)

Quantity:

Application:
Pressure
Jacketing / Sleeving
Tube Extrusion
Striping (Number of Stripes:)
Encapsulated? YES NO
Other (Specify)

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

Fittings Required:
Air Fitting
Vacuum Fitting

Specify quantities requested and any special instructions: