Raw Hose / Tubing Request Form

To ensure the accuracy of your quote for parts, please provide as much information as possible.

RAW HOSE / TUBING REQUEST FORM

First Name Email

Last Name Phone

Company

Address 1

Address 2

City

State

Zip

Do you have an account with us? Yes No - Download our Credit Application (PDF)

Type of Hose or Tubing (Water, Petroleum, Chemical, etc)

Size (Hose ID, Tube OD)

Wall Thickness

Media Flowing Through Hose (Chlorine, Asphalt, Dairy, etc)

Usage for Hose (Hydraulics, Venting, Suction, Discharge, etc)

Cover Material (Rubber, PVC, Metal)

Tube Material (Sanitary, Rubber, EPDM, etc.)

Reinforcement (2-Ply, Wire Braid, PVC Helix, etc.)

Color

Length

Maximum Temperature or Range

Maximum Pressure or Range (PSI)

Requirements / Standards (FDA, ISO, MSHA, SAE, etc.)

Part Number

Company / Manufacturer Preference

Substitutions Acceptable
Yes No
Quantity

Certificates, Packaging, Delivery, and Time Requirements
Add me to mailing list

Industrial Hose & Hydraulics

Raw Hose / Tubing Request Form