Jergens SFG Master Catalog

specialty fasteners SPECIAL PIN ORDER FORM

Kwik-Lok ® Pin Special Application Information

Special Kwik-Lok ® Pins

If you don’t see the exact Kwik-Lok ® Pin to meet your applica tion requirements, photocopy the form below, indicate your requirements, and send to Jergens.

Quotation Request Worksheet (online at www.jergensinc.com/tools/pins_rfq.aspx) SPECIAL PIN ORDER FORM

1. Pin Diameter

2

1

2. Grip Length

3

3. Overall Length

*For special Shank/Lanyard configurations – Please provide drawing or sketch.

Application (describe): Handle Style: T L Ring Button Recessed Button Kwik-Lok ® Lifting Pins Special Body Material: 17-4 PH heat treated Stainless Steel Other (describe) Number of Locking Elements: 2 balls(standard) 4 balls Attach Split Ring?

(yes/no)

*Lanyard Length:

(inch or mm) SS cable with nylon color

(Green,Black,Clear or other)

Attach Lanyard directly to Pin without split ring?

(yes/no) Attach to Split Ring?

(yes/no)

Tabs:

Round (Stainless Steel)

Oval (Aluminum)

Mounting Hole Size

(inch or mm)

Loop/Eyelet (Stainless Steel) with Mounting Hole: 0.19" for #10 screw

5.2mm for M5 screw

Quantity Required:

(pieces)

Request date:

Annual Requirements

(pieces)

NAME:

POSITION/TITLE:

COMPANY:

ADDRESS: COUNTRY:

CITY:

STATE:

POSTAL CODE:

TELEPHONE:

FAX:

E-MAIL:

28

Jergens, Inc. | 15700 S. Waterloo Road | Cleveland, Ohio 44110-3898 USA