Quote Form 106

Common Applications: P&H, Komatsu, Joy Global, Wound Rotor Motors, Draglines, Mining, Crane Machines

Please fill out as completely as possible
Name*
First Last
Company*
Account Number
Email*
Phone*
Street Address
Address Line 2
Address*
City * State / Province / Region * ZIP / Postal Code * Country *
Manufacturer
Power
Power Type
Applications
Primary Volts
Primary Amps
RPM
Sec/Exc Volts
Sec/Exc Amps
Type
Model
Frame
Brushes/Set
Brush grade/markings
Brush Part #
Holder Part #
HQD/Wear Device
- HQD
- Wear Device
Reference the image below for assistance with the following fields
Brush Box Thickness
Overall Width
Brush Box Width
Reference the image below for assistance with the following fields
Mounting Post Diameter
Center Post to Post
Brush Box Length
Slip Ring Diameter
Center Line Post To Ring Surface
Slip Ring Width
Photo/Document Upload
Maximum 3 Files
Drop files here or
Accepted file types: jpg, gif, png, pdf, Max. file size: 256 MB, Max. files: 3.
Would you like us to quote brushes as well?
- Yes
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