Curtis Machine Company, Inc. Logo
Snail Mail: P.O. Box 700, 4209 Jayhawk Drive, Dodge City, KS 67801-0700
Phone#: 1-620-227-7164     Fax#:1-620-227-2971
Toll Free in the USA: 1-800-835-9166

Application/Order Sheet
Les outils suivants ne sont disponibles qu'en anglais.

Company Name: * Contact Name: *
Phone: * Email: *
USA: please enter area code;
International: please enter Country code, City code, and Phone number
City: State:
Zip Code: Country:
Billing Address: Fax:
Shipping Address: P.O. Number:
(if ordering)

Is This a Prototype? Yes
Annual Usage: Release Qty.:
Horsepower or Torque: Hours of Life Required:
Please Select Shaft and Gear Arrangement Required:
(please note, the image will change with Netscape 3.0 or higher
You may need to click on the image on some browsers) 
Select Input Shaft Location:
Input RPM: Output RPM:
Shaft Diameter:
Shaft Length From Cap: Or From Centerline:
List Other Non-Standard Requirements
Please note driver and driven shafts:

 Please fill in the next section for Overhung Load Calculations
  Curtis Machine Company can calculate overhung loads when provided with additional information. Please fill in the following so that we can calculate your overhung load rating :
(See Overhung Load Diagrams on Engineering Data Sheet)
Overhung Load diagram
Location of Load, Clockwise in Degrees: Overhung Load Dimension:
(centerline of load to centerline of unit)
Rotation of Overhung Shaft: Clockwise
Driver Diameter: Driven Diameter:
Chain or Belt Center Line Spread: Unit Of Measure Used:

Please print this form and fax to 620-227-2971

Copyright © 1992, 1996, 1997 byCurtis Machine Company, Inc.