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Home
About
- Company
- Team
- Gallery
Services
Markets
Valued Clients
Testimonials
Application Form
- Agents/Reps
- Application Questionnaire
Contact

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Application Form

Company Name

Address

Address 1

Address 2

City

State

Zip

Contact Person

First Name

Last Name

Title

Department

Phone #

Fax #

Email Address

Describe The General Application Or Need & Installation Location

Feed Composition

Liquid

Gas

Feed Source

Operating Conditions

Operating Conditions

Pressure

Max.

Min.

Temperature

Max.

Min

Flow Rate

Type of Flow Rate

Continuous

Intermittent

If Intermittent or Batch Process, Describe

Feed Moisture / Contaminants Content

Product Moisture / Contaminants Content

Utilities Available

Utilities Available

Type of Utility

Electrical

Volts

Hz

Ph

Type of Utility

Natural Gas

Pressure

Temperature

Type of Utility

Steam

Pressure

Temperature

Type of Utility

Instrument Air Min / Max

Pressure

Type of Utility

Purge Gas Composition

Pressure

Temperature

Water Content

CFM Max.

Type of Utility

Cooling Water

Pressure

Temperature

Type of Utility

Other

Equipment Specifications

Equipment Specifications

Control

Manual

Semi-Automatic

Automatic

Electrical Enclosures

NEMA 1

NEMA 4

PLC

DCS

Hazardous Area

Class

Group

Div.

Other

Materials of Construction

Location

Inside

Outside

Protected

Unprotected

Minimum / Maximum Ambient Temperatures

Space Limitations ( L x W x H )

Mechanical Design

Pressure

Temperature

Properties

Viscosity

Heat Capacity

S. G.

M. W.

Optional Features Desired (List)

General Process Description / Remarks

Price

Firm Price

Budget Pricing

Budget Available

Date Required

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