| *Denotes a required field |
| Quote ref: |
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| Customer |
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| Hose specification |
| Hose type |
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| Nominal bore |
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| Hose length |
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| End fitting one |
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| End fitting two |
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| Working conditions |
| Maximum working pressure (Units measured in Bar) |
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| Vacuum requirements (Units measured in mBar) |
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| Please state minimum bend radius required |
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| Minimum bend note |
| NOTE: Minimum bend radii of ETH hoses are three times and not twice that of the standard GP+SS hoses featured in our product literature. |
| Fluid to be transferred (Please supply data sheet below if possible.) |
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| Minimum ambient temperature (Units to be measured in °C.) |
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| Maximum ambient temperature (Units to be measured in °C.) |
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| Location |
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| Will the hose be subject to external corrosion from chemicals or water etc? |
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| If yes, please describe |
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| Will the hose be subject to abrasion or mechanical abuse? |
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| Will the hose be supported or hanging from end fittings? |
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| Are there any maintenance requirements? (e.g. steam cleaning) |
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| If yes, please describe |
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| Brief description of the exact duty of the hose (e.g. tanker off loading) |
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| Heating requirements |
| Minimum temperature of product entering hose? (Units to be measured in °C.) |
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| Maximum temperature of product entering hose? (Units to be measured in °C.) |
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| Minimum temperature of product exiting hose? (Units to be measured in °C.) |
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| Maximum temperature of product exiting hose (Units to be measured in °C.) |
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| Minimum temperature to be maintained? (Units to be measured in °C.) |
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| Maximum temperature to be maintained (Units to be measured in °C.) |
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| Supply voltage |
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| Other supply voltage (If your supply voltage is marked as 'other' above, please specify.) |
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| Does your hose need to be... |
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| Which end of the hose is to have the electrical connection? |
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| What is the required length of the external heater leads? (Units to be measured in M.) |
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| Is a melt out facility required? (Only up to 120°C) |
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| If a melt out facility is required, please complete the following 5 questions. |
| Melt out time (hours) |
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| Flow rate (M/Min) |
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| Specific weight of media (Kg/M³) |
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| Specific heat of media (Kj/Kg/°C) |
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| Specific heat of fusion (Kj/Kg/°C) |
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| Area requirements |
| Has the area in which the hose is to be used been given a hazardous classification by any of the following bodies? (If none are applicable, please continue to the 'control requirement' section.) |
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| Please state which zone, temperature classification and gas group is pertinent |
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| Please state the temperature classification |
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| Are there any unusual external conditions? If yes, please describe (e.g. conditions that could create a potentially explosive atmosphere or fire risk due to an ignition source being present such as airborne dust or flammable vapours.) |
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| Please state the gas grouping (Further gases may be identified in Table 7 BS 5345:Part 1) |
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| Control requirements |
| Notes: When using a series or constant wattage heater, a temperature sensor is always required, in conjunction with a temperature controller. |
| It may also be necessary to use sensors and controllers with self-regulating heaters when very tight temperature limits are required. (Aflex will advise of this if applicable). |
| If Hazardous Area conditions it is possible to supply Special Hazardous Area Controllers for use with certain types of heaters. However, it is preferable that Standard Controllers be placed outside the Hazardous Area, preferrably a Non-Hazardous location. |
| The Hazardous Area Controllers are supplied with PT100 (RTD) temperature sensors connected to the hose via flexible conduit lengths of up to 1.5 metres are available for this type of controller. |
| Please indicate which type of sensor is required (if any) |
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| Other sensor type (If 'other' above, please specify.) |
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| Is a temperature control required? |
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| Please give further relevant information |
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| Position |
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| Contact information |
| Questionnaire completed by * |
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| Position |
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| Business email* |
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