Please fill out the following form to begin the quote process.
*Contact Name:
*Company Name:
*Email Address:
Application:
Reason for Analysis:
Gasket Type:
*Phone:
Fax:
Marketing Representative:
Estimated Annual Usage (EAU):
Desired Delivery Date:
   

Please enter data as completely as possible in either U.S. or Metric measurements.

Bolt Data (US): #1 #2 #3 #4
Number of Bolts:
Bolt Diameter (inches):
Bolt Torque(in./lbs.):
Grade/Class of Bolts:
Thread Type:
Bolt Grip Length:
Bolt Body:
Bolt Data (Metric): #1 #2 #3 #4
Number of Bolts:
Bolt Diameter (mm):
Bolt Torque(Nm):
Grade/Class of Bolts:
Thread Type:
Bolt Grip Length:
Bolt Body:
Flange Data: US Metric
Flange/Gasket Contact Surface Area: (sq. in.) (sq. cm)
Gasket Aperture Area: (sq. in.) (sq. cm)
Gasket Width: (inches) (mm)
Flange Width: (inches) (mm)
Flange Thickness: (inches) (mm)
Composition (Al, Fe, S or other):    
Longest Bolt Span: (inches) (cm)
Centerline Deviation: (inches) (cm)
Flange: Surface Flatness +/-: (inches) (cm)
Roughness: (RMS) (RMS)
Base: Surface Flatness +/-: (inches) (cm)
Roughness: (RMS) (RMS)
Stress Riser: Yes No Yes No
Weight of flange if over 5 lbs. (US) or 2 Kg (Metric): (lbs.) (Kg)
Environmental Data: US Metric
Maximum Temperature: (F°) (C°)
Sealed Fluid:    
Internal Pressure: (psig) (Mpag)

4701 West Rice St.
Chicago, IL 60651
773-626-8800 Tel
773-626-1430 Fax
 info@chambersgasket.com
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