REQUEST A QUOTE (LONG FORM)

If you have a simple request or know what you want, please use our simplified short form.

If we can offer you a proposal on a current or future application, please take a moment to fill in the following application form. We can specify with your parameters. (please fill in as much as possible).

Product to be metered or controlled:
Flow range:
Pressure:
Temperature:
Viscosity:
Specific Gravity:
Line Size in Inches:

Desired End Connections:	threaded flanged victaulic tri-clamp BSPT weld end DIN other
If other, please specify:

Mounting Environment:

simple case/indoors NEMA 4 weatherproof NEMA 6 submersible NEMA 7/4X explosion proof API6D fire safe

Desired Counter:

electronic local electronic remote mechanical NA

Counter Increments:	gallons liters cubic feet pounds cubic meters dekaliters kilograms barrels imperial gallons NA
If other, please specify:

Required Accessories:

Strainer mesh or micron rating, (only applicable to strainers or filters):

Would you like us to respond by:

email fax regular mail phone

Company Name:
Your Name:
Your Title:

Mailing Address
Address:
City:
State:
Zip Code:

Shipping Address (if different then above):
Address:
City:
State:
Zip Code:

Phone:
FAX:
E-Mail:

Are there any special materials of construction or seal material required, If so list:

Any additional notes on your application: