Date Required:

Customer, Distributor:

Contact Name:

Phone:

-- (req'd)

Fax: --

Total Thrust Required (Pounds)

Push:          Pull: 

System Operating Pressure (PSI):

Cylinder Series:

A:     MN:     LH:     H:     Other:

Mounting Style:

Horizontal:     Vertical:     Rod Up:     Rod Down:     Other:

Dimensions:

Bore:          Stroke:          Rod Diameter: 

Rod End Style:

Standard Rod End #:  

Cushions:

None:     Both Ends:     Rod End:     Blind End:     Special:

Ports - Rod End:

Type:          Size:          Location: 

Ports - Blind End:

Type:          Size:          Location: 

Stop Tube Requirements:

Tube Length:          Work Stroke:          Total Stroke: 

Speed:

Extend, inches per minute: 
Retract, inches per minute: 
Ambient Temperature, degrees Fahrenheit: 

Duty Cycles:

Cycles per hour: 

Operating Media:

Special Modifications, list:

Describe Application:

Refer inquiries to: Milwaukee Cylinder Customer Service 414-769-9700