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| Customer:

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Phone:

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| Mailing Address:

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Fax:

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| Shipping
Address:

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| Please check one
Distributor:
( ) OEM: ( ) USER: ( ) |
| (1) Tube/Pipe
Material:

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Tube/Pipe O.D.:

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Indicate size and
gauge

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| (2) Roller End Bearing
Material Type:
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| (3) Shaft Diameter:

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Indicate Round or
Hex:

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Shaft Material:

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| (4) Shaft Length:

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(5)Hex Shaft Adapter: Yes:
( ) No: ( ) |
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| (6) Distance Between
Frames:

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(7) Spring Loaded: Yes:
( ) No: ( ) |
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| (8) Drive Roller: Yes:
( ) No: ( ) |
(11) Specify V-Belt or
Round Belt Size & Distance: (See Drawing)

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| Load:lbs/Roller:

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Speed:fpm/Roller:

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| Special Roller
Concerns: (Temp., Chemicals, Wet or Dry, etc.)



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| FOR PRODUCTION
USE: |
| (9) Roller Length with
Bearings:

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(10) Overall Length
Including Hex Shaft Adapter:

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| (2) Roll End Bearing Part
No.:

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(5) Hex Shaft Adapter Part
No.:

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| (1) Tubing/Pipe
length:

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POBCO assumes a
total of 1/4" clearance total between frames dimension (1/8" on both sides) as
well as 1-3/4" additional shaft length (7/8") on both sides) beyond distance
between frames, unless otherwise stated by customer. POBCO can also furnish the
complete roller per your specifications or can supply the components (per
drawing) for your own assembly. A popular roller size is the 1-1/2" Schedule 40
PVC (1.900" O.D.) Pipe/Spring Loaded which comes with a variety of Bearing
materials including Plastic, Plastic/Stainless Steel Ball Bearings and
Lubricant-Filled Hardwood. |