Request a Quote

This field is hidden when viewing the form

Next Steps: Sync an Email Add-On

To get the most out of your form, we suggest that you sync this form with an email add-on. To learn more about your email add-on options, visit the following page: (https://www.gravityforms.com/the-8-best-email-plugins-for-wordpress-in-2020). Important: Delete this tip before you publish the form.

Name(Required)

First Last

Email(Required)

Enter Email Confirm Email

Company Name(Required)

Phone(Required)

Preferred Contact Method(Required)

Industry Type(Required)

Other (please specify)

Provide details on the what type of custom hose your would like to discuss.

Hose Specifications

Hose Type (Select the hose you are interested in)(Required)

Custom Hose (please specify)

Provide details on the what type of custom hose your would like to discuss.

Conveying Medium (What substance will the hose carry?)(Required)

Hose Size & Length:

Internal Diameter (mm/inches):

Wall Thickness (mm/inches)

Required Hose Length (metres/feet):

Working Conditions:

1. Working Pressure (bar/psi):

2. Temperature Range (°C):

3. Bending Radius (if applicable):

4. Required Flange Size (if applicable):

5. Will the hose be exposed to harsh environments? (e.g., saltwater, chemicals, extreme heat):

Application Details:

Describe Your Application (How will the hose be used?):

Is this hose intended for permanent or temporary use?

Do you require specific certifications?

(e.g., food-grade, chemical resistance, marine standards):

Additional Comments

Explain what type of certifications are required.

Additional Requirements:

Special Instructions or Customisations

(e.g., reinforcement, specific fittings, custom colours, logos)

Upload Files

Drop files here or

Accepted file types: jpg, png, pdf, jpeg, Max. file size: 50 MB, Max. files: 5.

(Drawings, Specifications, or Reference Images)

Delivery Information:

Preferred Delivery Date:

Delivery Location / Shipping Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Do you require expedited shipping?

Additional Comments or Questions:

Anything else we should know to provide an accurate quote?

Protect by reCAPTCHA

Request a Quote

Request a Quote

Next Steps: Sync an Email Add-On

Hose Specifications

Application Details:

Additional Requirements:

Delivery Information:

Additional Comments or Questions:

Marine & Industrial Hoses

Information

Customer Service

Our Hoses