Date Submitted
_________ Date Required _________ Submitted By
_________
Moss Seal Company
Engineering Action Request
Seals Division (Please describe only one sealing application per
E.A.R.)
Please Print Out This Form and Fax To 713-699-1349
CUSTOMER DATA
Company Name
__________________________________________________
Address ________________________________________________________
________________________________________________________________
City, State, Zip, Country ___________________________________________
Telephone _______________________________________________________
Telex ___________________________________________________________
Telefax _________________________________________________________
Contact Person ____________________________ Title ________________
Products Mfd/Sold/Serviced ________________________________________
________________________________________________________________
OEM
Distributor
Rebuilder
APPLICATION DATA
1. Is this application:
New Design
Retrofit
2. Type of seal:
Piston (O.D.) Rod (I.D.)
Rod Scraper Face ( Ext. Int.)
3. Type of motion:
Reciprocating Static
Rotary Oscillatory
4. Sudden changes in:
Temperature Pressure
Surface Speed
5. Temperature:
°C
°F
Min. _____Normal _____Max. _____
6. Pressure:
kg/sm²
PSI
Min. _____Normal _____Max. _____
7. Stroke Length:
mm
in
Min. _____Normal _____Max. _____
8. Surface Speed:
mm/sec
ft/min
Min. _____Normal _____Max. _____
9. Cycle Rate:
strokes/sec
strokes/min
Min. _____Normal _____Max. _____
10. Degrees of Rotation:
Min. _____Normal _____Max. _____
11. RPM :
Min. _____Normal _____Max. _____
12. Media being sealed
______________________________________________________
13. If retrofit, please describe why customer wants to consider a new seal
____________
_________________________________________________________________________
PERFORMANCE DATA
1. Maximum Allowable:
Static Friction____________________
Dynamic Friction _________________
Fluid Leakage ___________________
Drops/Cycle
cc/Hour
Other
2. Desired service life: _______________
Revolutions
Surface
meters
Surface
feet
Cycles
Hours
Years
3. Any special requirements?
_________________________________________________
__________________________________________________________________________
__________________________________________________________________________
HARDWARE DATA
All dimensions are in: Millimeters
Inches
Bore:
Dia __________
+_______
- _______
Mat'l _______
Finish _______
Hardness _______
Piston:
Dia __________
+_______
- _______
Mat'l _______
Finish _______
Hardness _______
Groove:
Dia __________
+_______
- _______
Mat'l _______
Finish _______
Hardness _______
Groove:
Width _______
+_______
- _______
Mat'l _______
Finish _______
Hardness _______
Rod:
Dia __________
+_______
- _______
Mat'l _______
Finish _______
Hardness _______
Rod Housing:
Dia __________
+_______
- _______
Mat'l _______
Finish _______
Hardness _______
1. Can hardware design be changed? No Yes
(How? __________________________
3. Indicate applicable hardware design requirements in
sketches below while showing pressure, magnitude and directions (with arrows).
4. Drawings, sketches, other info attached: No
Yes
(Describe ____________________________________________________________________
_____________________________________________________________________________)
COMPETITIVE DATA
1. Who is competitor?
______________________________________________________________
2. What is competitor's product?
_____________________________________________________
3. What wins the order?
Performance Price Delivery
Other ___________________
4. Are prototypes required? No Yes
How many? ____________ When? ____________
5. Estimated sales volume: _________________ Pieces, sets/month, year, project
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