Requisition Form
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Quick Release Coupling Details
(Please Tick as per your requirement)

* Indicates Compulsory Fields

Name of Company : *
Name of Contact Person :*
Address / City / Location : *
Tel. No. / Cell No. : *
Email : *
QTY :

Coupling Type : Single Shut Off
Double Shut Off
Through
Cam Lock
Special

Socket End Connection(With Size) :
Male Female
Hose Any Other

Size :

Plug End Connection :
Male Female
Hose Any Other

Size :

Type of Fluid Flowing Through Coupling :
Pressure of fluid :
Temperature of fluid :
Seal (If possible) :
Type of Lock :
Any Special Requirement : 
Attach File
Please, Enter Verification Code in the box: *

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