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Spare Parts 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:

...................................................................................................................................................................

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

I already own a BH head and I am interested in a quote for the following spare parts:

Heaters or Thermocouples
Barrel Body
Core Tube
Deflector*
Wedge Ring*
Adjusting Tube, Nut or Nut Holder
Replacement Screws, Bolts, Bushings or Seal Rings
Die Cup or Die Cup Holder
Spider or Bullet
Other (Specify)

*Please specify if . . . high volume or low volume is needed:

Please use tip or die worksheet for replacement tooling sets.

If you do not know the head assembly or parts you require,
please provide the following information. Email product drawing if available.

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

Barrel Body Outer Diameter:

Core Tube Outer Diameter:

Type of Polymer or Elastomer Extruded:

Specify quantities requested and any special instructions: