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Order Worksheet

Preferred Contact:
Name:*
Title:*
Company:*
Address1:*
Address2:
City:*
State:*
Zip Code:*
Country:*
Phone:*
Fax:
E-mail:*
Type Unkown for required fields when necessary
Project Name:
Quantity:*
Application Data:*
Inner Race Rotation:*
Outer Race Rotation:*
RPM of Rotating Race:*
Radial Load/LBS:*
Axial Load/LBS:*
Shock Load:*
Operating Temperature:*
Peak Temperature:*
Hours of Peak Temperature:*
Comments:
Bearing Part #
(if none, leave blank):
Bearing Environment:
Manufacturer Name:
Type of Bearing:

Existing Lubricant:
Lubrication Frequency:
Bearing Life: (weeks)
Cause of Failure: (if known)