Online Order Form

Below you can fill out the specific details of the hose you require. Once we receive your details we will contact you normally via email with a price and order details. Obviously not all fields apply to every hose but the more information you provide the quicker we can reply to your order.

Please note the below form is simply an enquiry form you will not be asked for a payment.

Order Your Silicone Hose

First Name:
Surname:
Telephone No.
Email Address:
Country:
Hose Type	Select... Straight Length 90° Degree Elbow 45° Degree Elbow 180° Degree Elbow Reducing Elbow Straight Reducer Other Type
Dimension/Bore Size:
If you selected reducing hose then fill out below the bore size you need to reduce from and to:
**From Bore Size:
**To Bore Size:
Hose Colour:	Select... Blue Black Other
Leg length	Select... 102mm (4") 152mm (6") Other
Hose Finish	Select... Standard Glossy Vintage
Quantity:
Other Details/Comments:

©2010 Derby Performance Hose Ltd

Unit 1, George Holmes Business Park, Swadlincote, Derbys, DE11 9DF
Silicone Hose