Process application form
•
Indicates required information
•
First name
•
Last name
Title
•
Company name
•
Mailing address
Suite number
•
City:
•
State
•
Country
•
Zip / Postal code
•
Area code &
phone number
Extension
Area code &
fax number
•
Email
address
Process fluid
Name
Process conditions
Line size
Pressure
Temp
Density / specific gravity
Viscosity
Describe the upstream piping conditions
Minimum flow rate
Maximum flow rate
Abrasive:
Yes
No
Solids:
Yes
No
If solids yes, indicate percent
Application
Measure
Monitor
Control
Mass balance
Preferred Differential Primary Element
Venturi
Other - Please list below
Lo-Loss® Flow Tube
Flow Nozzle
Orifice plate
Pitot Tube
Performance criteria
Accuracy + or -
Max permanent pressure loss
Repeatability + or -
Minimum differential
List other technologies being considered
Project status
Planning
Purchase in 3 months
Purchase in 1 year
Budgetary
Purchase in 6 months
Follow up
Please call to discuss
Please send literature
Please have local representative call
Additional Comments
