Company Name: 

Name: 

Phone#:                Fax#:

E-mail:

THE FOLLOWING OUTLINES THE INFORMATION NECESSARY FOR PROPER ELECTRIC MOTORS, GEAR
DRIVES AND DRIVES RECOMMENDATIONS.

MOTOR CHARACTERISTICS:

HP:     VOLTAGE:

PHASE:     HERTZ:

RPM:     FRAME STYLE:

NEMA FRAME:     

OVERLOAD PROTECTION:     F.L. AMPS:

DIM. (INCHES):

ELECTRIC MOTORS, GEARMOTORS AND DRIVES BEING REPLACED

MANUFACTURER:

SERIAL NUMBER:

TYPE:     MODEL:

HP:     VOLTAGE:

PHASE:     HERTZ:

RPM:     FRAME STYLE:

NEMA FRAME:     APP. WEIGHT:

OVERLOAD PROTECTION:     F.L. AMPS:

CONSTRUCTION TYPE:

WHY IS IT BEING REPLACED:

ENVIRONMENTAL CONDITIONS:

DUST, MOISTURE, FUMES & FIRE HAZARDS, etc: 

NOTES: