Estimated Annual Quantity:  
 Estimated Order Quantity:  
       Number Of Releases:  

Company:  
Contact:  
Address:  
   City:  
  State:  
    Zip:  
  Phone:  
    Fax:  
  Email:  

Project Name Or P/N:


Description Of Application:  

Molon Motor Type:  
         Voltage:  
       Frequency:  
    Power Supply:  

Rotation (Looking At Output Shaft):
                   Clockwise  Counter Clockwise

Reversible:
                   Yes        No
  
RPM (Include allowable variation)
      Under Load:  
         No Load:  

Torque:
       Full Load:  
        Starting:  

Above Torque Information Is:
                   Measured   Estimated

Is motor subject to shock load?
                   Yes        No
If yes, please describe:


         Axial Load:  
      Overhung Load:  
Ambient Temperature:  

Environment (water, salt spray, etc...)


Duty Cycle:
            On Time:  
           Off Time:  
     Cycles Per Day:  

Will Motor Be Stalled?
                      Yes  No

Motor Life:             YearsHoursCyclesOther

Shaft (Include Tolerance):
                   Diameter:  
     Length, Opposite Motor:  
                 Over Motor:  

Termination (Lugs, leads, connectors):


Rotor Brake (AC Only):
     Yes  No

Rotor Clutch (AC Only):
     Yes  No

Mounting Position:
     Output Shaft HorizontalOutput Shaft UpOutput Shaft Down

Is over temperature protection required?
     Yes  No
If yes, please describe:


Regulatory Agency Requirements (UL, CSA, CE, Etc...)


Have any other motors been tried?
     Yes  No
If yes, with what success?


Any additional information or notes: