Company*           Date     

Address*           Ref.       

City / State*      Rep.     

Contact            Phone #* 

Title              FAX #    


APPLICATION  (driven equipment):  
                                 

Duty Cycle   hours/day      Input Speed   RPM      Output Speed   RPM


PRIME MOVER:

  Electric Motor:

      Size   HP          Speed   RPM        Soft Start  

     Frame         NEMA Design           AC       DC  

Variable Speed:

   Minimum   RPM       maximum   RPM     AC       DC   

Preferred Mounting:

             Foot                Flange


Engine:

      Size   HP          Speed   RPM

      Type           No. of Cylinders  

Hydraulic Motor:

           Size   HP     Speed   RPM

SAE Size & Type  

LOAD PROFILE:

 Normal Running Load:   Lb. - In.    Duration  

       Starting Load:   Lb. - In.   Frequency      Duration  

           Overloads:   Lb. - In.   Frequency      Duration  

      Reversing Load:       Frequency  

      Impact Loading:       Frequency  

     Brake In System:            Type      Capacity   Ft. - Lbs.

            Location:  
																	
OVERHUNG LOAD:

Input Shaft:    

                 Type       Pitch Diameter   in.

    Position On Shaft  
	
Output Shaft:

             Sprocket              Pinion  

       No. of Strands      Pitch Diameter   In.    Face Width   In.
	
    Position on Shaft  
																				   
POWER FLOW:

         Concentric Shaft      Parallel Shaft  

            Off-set Shaft         Right Angle  

  Input Shaft: Horizontal            Vertical     Up      Down     Slope Angle  

 Output Shaft: Horizontal            Vertical     Up      Down  

 Input Shaft Rotation: CW                 CCW   (looking at input shaft)

ENVIRONMENT:

Ambient Temperature:

        Maximum    Degrees F     Minimum    Degrees F

Location:

         Indoors     Outdoors       Enclosed (Poor Circulation)  																				   

Direct Sunlight      Washdown                       Dusty/Dirty  

ACCESSORIES:

           Input Shaft Coupling             Output Shaft Coupling  

  Motor Adapter (flanged motor)        Motor Bracket (foot motor)  

                       Bedplate          Motor Mount (belt drive)  

SPECIAL SHAFTS (describe):

            Input  

           Output  

MISCELLANEOUS:

Identify any other factors which may influence the selection of a gear drive for
this application:

																			   

                Delivery Required   Weeks

         Number of Units Required  

                      Destination