Block Brush Worksheet

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Block (Lag) Staple Set Brush

Worksheet [R. 02.2015]

E
F

G Contact Name: ___________________________________________

A Company Name:__________________________________________

D Phone: ___________________________________________________

Fax: _____________________________________________________

C Email: ____________________________________________________

Specifications
Quantity to release per order: ______

Are there drawings or sample


BLOCK: available for reference? q Yes_ q No
Material: q HDPE q Polypropylene q Wood q Other _______________
A. Height (Thickness): ____________ B. Width ____________ C. Length ____________
APPLICATION -Please be sure to
identify any special factors that should
BRUSH PATTERN: be considered such as FDA approved
D. Distance between block edge and center of 1st tuft: ______________________________ material, temperature, moisture, chemical
exposure, etc.:
Same on both ends? q Yes q No
_____________________________________
E. Width of brush face area: ____________ F. Length of brush face area: _____________
_____________________________________
Size of hole (tuft diameter):
_____________________________________
q .118 in/3.0mm q .157 in/4.0mm q .217 in/5.5mm _____________________________________
q .256 in/6.5mm q .315 in/8.0mm
Number of holes (WxL) : _____________ x _____________
Face Density: q Heavy q Medium q Light
Hole Pattern: q Straight q Staggered straight staggered

FILAMENT/TRIM:
G. Filament trim height: ______________ Filament diameter: ______________
Material: q Nylon 6.0 q Polypropylene q Horsehair q Other: ___________
Filament Shape: q Level q Crimped Trim Shape: q Flat q Beveled

level crimped flat beveled

8000 Whitepine Road e: industrial@sealeze.com t: 1.800.787.7325 ISO 9001 Certified


N. Chesterfield, VA 23237 www.sealeze.com f: 1.800.448.2908 A Jason Company

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