Valcor Scientific - Application Data Form
 
Project/ Proposal No: (assigned by Valcor):
Company:
Contact:
Title:
City:  State:  Country:
Tel #
Fax #
Email:
 
Products manufactured at this site: (fill in above)
 
Description of Application
New Application    Replacement  
Reason for Replacement: (check all that apply)
Performance Delivery  
Quality Pricing  
Prototype:    
Quantity Required: Date Prototype Req'd:
Production:    
Annual Quantity: Lead Time to Production:
Target Cost:    
 
General Description of Application: (fill in box below)
Valve Type: 2-way 3-way Normally Closed Normally Open Diverter Selector
Port Size: Port Type:
Fluid: Fluid Temp: Amb. Temp:
Materials in Contact with Fluid:
Elastomers:
Plastics:
Metals:
Flow Requirement:(Max)    
Orifice Dia. Cv:
Voltage: Power:
Inlet Pressure: Backpressure:
Enclosure: Electrical Termination:
Duty Cycle: "ON" Time: "OFF" Time:
Cycle Rate: Operating Life: (cycles)    
Response Time: to "open" to "close"
 
SKETCH of Application:
Show location of valves or pumps in system and relative pressures and flows:
 
Special Requirements: (i.e. Mounting Orientation, Cleaning, Packaging, etc.)
 
Additional Instructions to Valcor:
 
  
 
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