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Application Eng. Forms
Light-Duty
Medium- & Heavy-Duty

APPLICATION ENGINEERING FORM (LIGHT-DUTY)
(Red items are required.)

Please use this form only if you are able to provide all of the data requested below. Otherwise, use the Send Us a Message form. Thank you.

CUSTOMER INFORMATION
(mm/dd/yy)

Company:

Date:

First Name:

Middle Name:

Last Name:

Title:

Address Line 1:

Address Line 2:

City:

State:

Zip/Postal Code:

Country:

Phone:

country
code
area/city
code
phone number
+ ( )

Fax:

country
code
area/city
code
phone number
+ ( )

E-mail:

Company
Category:

REQUIREMENTS

Prototype Required:  Yes  No    Date:     Quantity:    units

Pilot Builds Required: Yes  No    Date:     Quantity:    units

Start of Production Date:       Vehicle Life Cycle:    Years

Commercial Annual Production Volume:

Year 1

Year 2

Year 3

Year 4

Year 5

Year 6

Year 7

Year 8

Year 9

Year 10

Shipping Details (Check One for Each Item):

Air Freight

Sea Freight

Surface

Ship Date

Prototype

Pilot

Commercial Production

VEHICLE SPECIFICATIONS

Manufacturer:

Model:

Type:

Usage:

OE
Aftermarket

Market(Country):

GVW:

 

Max. Gradeability Required:

%

Max. Speed Required:

 

Ambient Temperature:

Max.

Min.

TRANSMISSION SPECIFICATIONS

Model:  

Number of Gears:  

Type:     Conventional Inline    Front Transaxle    Rear Transaxle*

* If Rear Transaxle, then specify

Position:   Transmission in Rear  Transmission in Front

Ratios:

1st 

2nd 

3rd 

4th 

5th 

6th 

Rev 

ENGINE SPECIFICATIONS

Manufacturer:

Model:

Fuel:

 Gasoline
 Diesel

Displacement:

 

Engine Location:

Max. Power:

  @

RPM

Max. Torque:

   @

RPM

Idle Speed:

 RPM

Torque at Idle Speed (if available):

 

Torque Curve Available:

 Yes*    No

* Note: If Yes, please provide "torque curve" for engine in a separate file.

CLUTCH

Manufacturer:

Model:

Type:

Bell Housing:

 Required*

 Not Required

* If required, provide design drawing

Flywheel and Clutch Assembly Inertia:

  

Clutch Disk Diameter:

Clutch Release System (check all that apply):

Hydraulic

Mechanical

Concentric

Remote Slave Cylinder

AXLES

Type:

Live Axle  IRS

Driveline:

Front:

Model:

Type:

Ratio:

Rear:

Model:

Type:

Ratio:

PROP SHAFT

Type:   Fixed Yoke    Slip Yoke

TIRES

Size:

Revolutions:

per

TRANSFER CASE

Manufacturer:

Model:

ACCESSORIES

P.T.O. Requirements: 

Other Accessories Required: 

Reverse Switch Required?   Yes  No

Neutral Switch Required?   Yes  No

Speedometer Drive Requirement:   

Reverse Inhibitor?   Yes  No

*If Yes, please specify  Type: Mechanical  Electric

Skip Shift Solenoid Required?  Yes  No

NOTES & ADDITIONAL INFORMATION

ADDITIONAL INFORMATION FOR INSTALLATION

Size A

mm

Size G

mm

Size B

mm

Size H

mm

Size C

mm

Input Shaft Pilot Dia.

mm

Size D

mm

Input Shaft (Spline Count)

Size E

mm

Output Shaft (Spline Count)

Size F

mm

Output Shaft Design

flange slip yoke

     

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