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CONTACT INFORMATION

Company Name*
Contact Name*
Address*
Phone Number*
Fax Number
Email*
RFQ No.*
Account Type*	Distributor End User Other:

PRODUCTS

O-ring T-seal Back-up Ring Custom Molded

SIZE

AS568 Dash No.
OR Dimensions (in inches)
Inside Diameter
Cross Section

1 -	Type	Rod Piston
2 -	Standard Size OR
	Attach Drawing
3 -	Back-up Rings	Not Required Nylon Teflon

Standard Size OR
Attach Drawing

Attach Drawing

MATERIAL INFORMATION

Please provide one of the folowing :

Parco Compound (6 or 8 digits)
Elastomer
Durometer (Shore A)
Attach Material Spec.

ADDITIONAL INFORMATION

Quantity
Target Price (USD)	each
Inserts	Not Required Parco to supply Account to supply
PPAP	Not Required Level 1 Level 2 Level 3 Level 4
Other Requirements	Enter other requirements here...

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