The following information must be kept confidentialYESNO

YOUR INFORMATION:

COMPANY NAME:

YOUR NAME:
YOUR TITLE: 

ADDRESS 1:
ADDRESS 2:
ADDRESS 3:
PHONE:EXT:FAX:
E-MAIL:

The bearing will turn at:RPM.
The load on the bearing is:lbs. radial andlbs. axial.
Will the bearing be subject to shock load?YESNO
The actual temperature of the bearing isF for hours with a peak temperature ofF forhours.

THE BEARING ENVIRONMENT IS:

DESCRIBE THE BEARING:

MANUFACTURER:
MODEL:
STYLE (ANGULAR CONTACT, TAPERED ROLLER, ETC.):
SIZE ID:inch(es) SIZE OD:inch(es) WIDTH:inch(es).
CURRENT LUBRICANT:
Do you relubricate the bearing:YES, How often?NO
CURRENT BEARING LIFE:
CAUSE OF FAILURE:
How many of these bearings are in this application?

OTHER COMMENTS: