Electric Actuator Specification Form

Please provide the following contact information:

Contact Information

	Name
	Title
	Company
	Address
	City, State Zip	,
	Phone
	Fax
	Email Address

Electric Actuator Specification

Breakaway Torque (in-lb)

Voltage
	AC DC
Fail Safe?
	Yes No
Duty Cycle
	10% 25% (Standard) 75% 100%
Motor Enclosure Type
	NEMA I NEMA IV NEMA VII / IX
Positioner
	No Yes
	Type of Input Signal for Positioner (If Selected)
		4-20 mA Other (Specify)
Extra Limit Switches? (Two Already Furnished)
	No One Extra Limit Switch Two Extra Limit Switches