Company:_______________________________   

Address:_________________________________ 

Contact:_________________________________

Phone:__________________________________

Fax:_____________________________________

email:___________________________________

CUSTOMER REQUIREMENTS

Fluid Name: ____________________________

     Gas:   __________

     Liquid:__________

Flow Rate:

     Normal: __________

     Maximum:__________

Operating Tempature:____________________

Operating Presssure:_____________________

Specific Gravity/Density:__________________

Viscosity @ Temp.

     cps: __________

     ctks:__________

     other:__________

Accuracy (% of Full Scale)_________________

     (+/- 10%)  (+/- 5%)  (+/- 2%)  (Special)

Other Function Requirements:

     Indicate: __________

     Alarm:    __________

     Transmit:__________

     Other:    __________

Mounting: In-Line or Rear of Panel

________________________________________

Size:                      

     Line Size: __________

     Connection type:___________

Materials of Construction:

Tube Material:__________

Fitting Material:__________

         O-Ring/Packing Material:__________

Connection Orientation:

Vertical:__________

Horizontal:__________

Valve:

None:__________

Inlet:__________

Outlet:__________

Scale Information:

Direct Reading or Percent:_______________

Alarms:

Single:__________

Dual:__________

SPDT or DPDT:__________

110Vac, 220Vac or 24Vdc:__________

Certifications:

_______________________________________

 ______________________________________

_______________________________________

Options/Extras:

_______________________________________

_______________________________________

_______________________________________

Number of meters:__________