Please complete the following brief application questionnaire and click Submit.

A Kirkpatrick Group representative will contact you within one business day.

The information submitted is used to better fill your wire rope lubrication needs and will remain confidential.

(REQUIRED)

Your First Name:
Your Last Name:
Your Title:
Company Name:
Address:
Address 2:
City:
State:
Zip or Postal Code:	-
Country:
Telephone:
Facsimile:
E-Mail:
	(Example: myname@mycompany.com)
Individual In Charge:
Title:

Briefly describe your application(s):
What are your Wire rope sizes, lay, and configuration?
What are the minimum and maximum wire rope travel speeds of each rope in feet per minute?
	(Please estimate if you do not know the exact speeds. Include minimum & maximum speeds. Can the speed be adjusted during operation?)
Please describe the condition of the wire rope to be lubricated:
	(Please tell us if the wire rope is coated with old lubricant, salt, corrosion, etc...)
In what size container	do you currently purchase your wire rope lubricant?
5 Gallon Pail
16 Gallon Mini-Drum
55 Gallon Drum

What is the viscosity of your preferred wire rope lubricant?
	Example: NLGI "0" - 90WT oil (density of room temp. molasses) Example: NLGI "1" - (density of non pourable soft butter) Example: NLGI "2" - (density of room temp. peanut butter)

Who is the manufacturer of your current lubricant?

How do you currently	perform your wire rope lubrication?
Drip Feed
By Hand
Spray
Pressure Lube
If other, or a combination, please specify:


How much time does your current lube method take?

What is the average temperature range which will exist during the lubrication process?
	(Please indicate Farenheit, Celcius or Kelvin)
What is the maximum air pressure output of your compressed air supply?	(PSI-G)

How far from the application is the compressed air supply which will be used to power your system?
	(Please indicate whether the air source will be shared or dedicated to the lubrication process)

What is your compressors size?

How did you hear of our product line?

Additional comments: