This form is for new motor samples only.
For replacements, please call the Original Equipment Manufacturer.
McMillan Electric Company
Engineering Sample Request (ESR) Form (Ref. MQP-042)
Accepted by: ___________________________ Sample No.: ___________________________
Date:
Customer Name:
Contact Person:
Customer Model Number:
Customer Part Number/Drawing Number:
Bill & Ship To:
Check One:
Types:
Ship Via:
Prototype:
PSC - 4 Pole:
Shaded - 4 Pole:
Volts:
Hertz:
1. UPS/Regular:
Production Model:
PSC - 6 Pole:
Shaded - 6 Pole:
Horsepower:
RPM:
UPS/Air:
(Required Engineering)
PM:
Shaded - 2 Pole:
2. McMillan Truck:
3. Other:
Number of Speeds:
Insulation Class:
Duty Cycle:
Application:
Minimum Required Locked Rotor Torque:
In/Oz
Anticipated Annual Usage:
Minimum Required Running Torque:
In/Oz at
RPM
Environmental Condition:
Motor Rotation Viewing
Overload Protection:
Operating Position:
Bearing Type:
Shaft End:
Normal:
CW:
Auto Reset Thermal:
Vertical/Shaft Up:
Light Duty:
Dusty:
CCW:
One-Time Fuse:
Vertical/Shaft Down:
Extended Life:
Moist:
Reversible:
Dual:
Horizontal:
Ball/Sleeve:
Ambient:
Impedance:
Shaft:
Endbells:
Lead End
Opposite Lead End
Leads:
Shaft Diameter:
Open Face:
Length:
Gauge/Material:
Extension Lead End:
Totally Enclosed:
Strip:
Terminals:
Extension Opposite Lead End:
Periphery Vents:
Plug:
Other:
Overall Shaft Length (If Double):
Double Oiling:
Lead Location:
Skeleton:
Shaft End:
Opp. Shaft End:
Brushes
Commutator:
Periphery:
Face:
Length:
Width:
Height
Dia.:
O'Clock:
Grade:
Shunt:
No. Bars:
Lead Exit Insulation Type:
Brushing:
Strain Relief:
Ferrule:
Other:
Ground Lead:
Location:
Type:
Magnets:
Length:
Grade:
Capacitor:
Paint Finish:
Bolts:
Mounted:
Loose:
Standard (White):
Type: 8-32:
10-32:
Other:
Rating:
(mfd)
Other:
Extension: Lead End:
Opposite Lead End:
Capacitor - Provided by:
Thermocouples:
Recognition:
McMillan:
On Windings:
Yes:
No:
U.L.: Yes:
No:
Customer:
In Bearings:
Yes:
No:
CSA: Yes
No:
Request Submitted By:
Phone:
Representing:
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