Company *:

Contact Person *:

Postal Address:

Email Address *:

Telephone *:

Fax:

* = Required Fields

Valve type:

How many revolutions does the travel have?:

Does the valve have a rising or
stationary spindle?:

Torque in Nm (highest value within its 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 or running time
of actuator 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?: