Glands and Seal Kits Quote Request

    Complete the form and submit using the button at the bottom of this page. A D.A.S. Services employee will be in touch shortly to help you with your request.

    Company Information

    Company Name (required)

    Contact Name (required)

    Your Email (required)

    Telephone (required)

    Street Address (required)

    Mailing Address (leave blank if same as above)

    City (required)

    State (required)

    ZIP(required)

    Cylinder Information

    Cylinder Description

    Cylinder Type

    AirHydraulic

    Cylinder Fluid

    Cylinder Part Number (Model or Serial Number)

    Gland/Seal Kit Information

    Gland/Seal Kit/Seal Number

    Sample Available?

    YesNo

    Quantity Needed

    Requested Due Date (For rush jobs, please call 260-833-6374.)

    Seal Material

    UrethaneBuna rubberHigh temp vitonOther (Please describe in comment box below)

    Seal I.D. Size

    Seal O.D. Size

    Seal Height (lying flat)

    Please leave any special requests, comments, or questions.