Application form Basic InfoFirst Name*Last Name*TitleCompany NameMailing Address Suite NumberCityStateCountryZipArea Code and numExtArea code and faxEmail (valid email required)* Process FluidNameProcess ConditionsLine SizePressureTempDensity/Specific GravityViscosityDescribe upstream piping conditionsMinimum flow rateMaximum flow rateAbrasive Yes No Solids Yes No If solids, indicate percentApplication Measure Monitor Control Mass balance Preferred Differential Primary Element Venturi Lo-Loss® Flow Tube Flow Nozzle Pitot Tube Other - Please listPerformance criteriaAccuracy + or -Repeatability + or -Max permanent pressure lossMinimum differentialList other technologies being consideredProject status Planning Budgetary Purchase in 3 months Purchase in 6 months Purchase in 1 year Follow Up Please call to discuss Please send literature Please have local rep call Additional commentsTen minus five equals Δ
