Name: *


Company: *


Email: *


Phone 1: *


Phone 2:


Billing Address: *


Shipping Address: *


Required Torque Spec:


Tool used for: Assembly, Disassembly, or Both?
Assembly
Disassembly
Both

Square-drive Tool?:
3/4" Square-drive (up to 1,000 ft. lbs.)
1" Square-drive (up to 3,000 ft. lbs.)
1-1/2" Square-drive (up to 10,000 ft. lbs.)
2-1/2" Square-drive (10,000+ ft. lbs.)

Low-clearance Tool?:
Yes
No

Low-clearance Tool Hex-link Size (nut or bolt across-the-flats):


Tool Calibration Certification required?
Yes
No

Pump (Power Pack) [comes with 15' twin-lined, 10,000 psi hose]:
Electric - 115v
Electric - 230v
Pnuematic

Pump Gauge Calibration Certification required?
Yes
No

Accessories:
Sockets (specify size[s] needed in "Additional Information" field):
Reaction Fixture:
Hex drives (specify size[s] needed in "Additional Information" field):
Other (describe in "Additional Information" field):

Additional Information


Purchase Order:
Yes
No

Attach copy of Purchase Order:


Credit Card:
None Mastercard Visa American Express Discover Other

Name as it appears on card:


Credit Card Number:


Credit Card expiration date


Sercurity code (three digit number on back of card):


Other information: