Company *:

Contact Person *:

Postal Address:

Email Address *:

Telephone *:

Fax:

* = Required Fields

Valve Type:

Travel 90°, 180°, other:

Torque in Nm (highest value within the travel
e.g. in the closed position):

Valve Manufacturer and Type?:

Will this actuator be used to replace
an existing actuator?:

Is explosion protection required?:

Is a manual override required?:

Is failsafe operation required?:

Do you require TA-Roloff to mount
the actuator on the valve?:

How is the mounting flange designed?:

Voltage of power supply:

Is a plug connection required?:

Position feedback?:

Required operating time?:

Operating a regulating valve?:

How many starts per hour?:

Where will the actuator be installed?:

Are the surroundings particularly cold or warm?:

Are the surroundings corrosive?:

Is vibration to be expected?:

Is special documentation required?:

Number of Items:

Delivery date:

Desired Mode of Shipment:

Already a customer of TA-Roloff?:

Are you the actuator’s end user?: