• PLEASE STOP and consider this thought:
  
  A mechanical seal should solve your problems.
  
  To maximize the service life of your mechanical seal it should be designed to suit your needs; to help us accomplish this we need you to fill out the following form. The information you provide will be forwarded to the appropriate engineer(s), who will evaluate the overall situation and determine the most appropriate seal for your needs.

Business Information
 	Your Name:

     Company Name:

 	  Address:

 	     City:

 	    State:

 Zip Code/Postal Code:

 	    Phone:

	      Fax:

	    email:

This product is to be installed in:
A New Piece of Equipment
An Existing Piece of Equipment

• If installed in an existing piece of equipment, will it... Replace a Packing or
  Replace a non Flowserve Product. If So, Describe: or
  Replace a Flowserve Product. If so, Flowserve Assembly#: REV:

Pump Description

  Pump Manufacturer:

 Pump type and size:

• Horizontal Vertical

Number of Stages

Number of Stuffing Boxes

Revolutions Per Minute

Pump Serial #

• Rotation viewed from driver end (required for pumping ring designs) Clockwise Counter Clockwise

Special Part Requirements

Shaft Sleeve style
12345NONE Material:  

Seal Flanges Style
ABCC-1DDJE44JNONE Material:  

Flange Bushing Style
12345NONE Material:  

Shaft Sleeve Gasket Material:
 "0"-ring
 Flat
 Triangular


Flange Gasket Material:
 "0"-ring
 Flat
 Spiral Wound

Pumping Conditions


Product (be specific): 

Temperature:  Fahrenheit Celsius


CleanSlurryAromaticToxicCorrosiveAbrasive 


Viscosity at pumping Temperature: 


Specific Gravity at pumping Teperature: 


Vapor Pressure at Pumping Temperature:  
PSI:  kPa: 


Stuffing Box Pressure:   
PSI:  kPa: 


Suction Pressure:   
PSI:  kPa: 


Discharge Pressure:   
PSI:  kPa: 

Piping Requirements


API Plan #: 


Water Jacket Cooling

Meduim:  


Cooling Temperature:  Fahrenheit:  Celsius: 


External Flush Fluid:

Flush Temperature:  
Fahrenheit:  Celsius: 


Flush Pressure:   
PSI:  kPa: 


Flush Flow Requirements:  
US Gallons/Minute:
Liters/Minute:


Cyclone Seperator Model: 


Heat Exchanger Model: 

If required, customer will machine:

Box Bore

Shaft

Shaft Sleeve/Nut

Shaft Key Way

Additional Flange Bolting

other: 


Notes:



	

	© copyright Gaskets, Packings and Seals Inc., 1997, All Rights Reserved