Technical Service Form

If you would like us to advise you on your gasket application, please provide the details requested below, and a technical expert will review the data and respond within 48 hours. Forms can also be printed and faxed to 937.498.4911 or mailed to: Thermoseal Inc. 2350 Campbell Road Sidney, OH 45365 Phone: 937.498.2222 or Sales at 800.990.7325 Fax: 937.498.4911
I would like a visit from a Thermoseal Inc. sales representative. Yes No
DUTY
Medium
Concentration
Max. Pressure
Max. Temperature
Liquid or Gas?	Liquid Gas
Any other comments (cycling, vibrations, food, hazardous, etc.)
FLANGES
Pressure Rating/Class
Nominal Size
Flange Material
Surface Finish
Type (flat faced, raised, etc.)
If non-standard, please give dimensions
BOLTS
Quality/Grade
Number
Diameter/Length
Lubrication/Type
GASKET DETAILS: (Dimensions)
1.Full Face
Outside Diameter
Inside Diameter
Number of Holes
Hole Diameter
- OR -
2.Ring
Outside Diameter
Inside Diameter

- OR -

3.Special Design	Please fax or email drawing and/or stressed gasket area.

CURRENT APPLICATION (Material and Thickness)

REASON FOR MATERIAL CHANGE (e.g., leaks, blow out)

CONTACT INFORMATION
Name
Title
Company Name
Street Address
City
State/Province
Zip/Postal Code
Country
E-mail
Phone
Fax
Request KLINGER®expert	Yes No

Or print, complete and fax this form to 937.498.4911 for assistance.