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Special model tailored to customer specifications

In order to be able to draw up a binding quotation for a special model, it is necessary that you answer the following questions as precisely as possible.

Please add the necessary information, then print out the page and return by fax to the following number: +49 (0) 2150 7053-11

Address of inquirer
Company
Street
Postcode/City
Contact Person
Tel.
Fax.
E-mail
   
Purpose of use
   
Number of packers
   
Borehole dimensions  
Diameter
Depth
Inclination
Inflation pressure
   
Packer dimensions  
Outer diameter of sleeve part      
Length of sleeve part
Inner diameter of mandrel
Total length
   
Metal material  
Steel
Stainless Steel
   
Threads  
Standard
Other
   
Inflation type  
Single
Double ( ventilation option )
   
Inflation medium  
Nitrogen
Water
Oil
Other
   
In-situ temperatures  
Max (°C):
Min (°C):
   
Packer exposure to different fluids  
Water
Saline water
Oil derivative
Oil
Acids
Leach
Other  
   
Technical documentation  
Yes (has to be enclosed)
No
   
Requested delivery time
   

Remarks (questions,  wishes, accessories)

   
Date:
   
 
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