*Name:

Title:

Company:

*Address:

*City:

*State or Provence:

*Zip Code or
Postal Code:

*Country:

*Phone:

Fax:

Email:

Quote #:

Reference #:

Fluid Properties:

Fluid Name:

Fluid Type:

Density, Specific Gravity, or Specific Volume:

Viscosity of Liquid at Operating Temperature:

Is the conductivity of the liquid at operating temperature greater than 3 uS/CM:

Required material of wetted parts (compatibility):

Installation:

Pipe Size:

SCH:

Mounting Connections:

Condition of Flow:

Inches of straight pipe without obstruction or bends up stream ofthe flowmeter:

Inches of straight pipe without obstruction or bends down stream of the flowmeter:

Installation:

Accuracy:

Ambient temperature range around the flowmeter:

Price:

Flowmeter Outputs and Accessories:

Comments: