Company *:

Contact Person *:

Postal Address:

Email Address *:

Telephone *:

Fax:

* = Required Fields

Valve Type:

Required valve material?:

Control or shut off valve?:

Inner diameter (DN) of the valve?:

Pressure rating (PN) of the valve?:

Which substance will be carried through
the system?:

Substance temperature?:

Will this valve be used to replace
an existing one?:

Is explosion protection required?:

Is a manual override required?:

Is failsafe operation required?:

Connection voltage:

Is a connecting plug required?:

Position feedback?:

Required operating time?:

How many starts or running time
of valve per hour ?:

Where will the valve 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?: