Name:

Company:

City, State, Zip:

Phone:

Fax:

Email:

Thread Size and Pitch:

Head Make, Model, & Style:

Thread Form (60 degree, acme, etc.):

Preferred Steel (e.g. D-2, M-1, etc):

Number of dies per set:

If Pipe Rolls, specify Series (NPT, NPTF, BSP, etc.):

Part Material:

Part Rc:

Diameter (inches)

Workface (inches)::

Bore (inches):

Keyway width (inches):

Number of starts:

In-Feed or Thru-Feed:

Describe any non-standard features required on thread rolls (e.g. radius root run-out, extended throat chamfer/lead-in, spline drive, etc):

Describe current thread rolling problems on this application:

Desired thread roll quantities to quote:

If long run job, approximate annual number of thread rolls used: