Application form Basic InfoFirst Name* Last Name* Title Company Name Mailing Address Suite Number City State Country Zip Area Code and num Ext Area code and fax Email (valid email required)* Process FluidName Process ConditionsLine Size Pressure Temp Density/Specific Gravity Viscosity Describe upstream piping conditionsMinimum flow rate Maximum flow rate Abrasive Yes No Solids Yes No If solids, indicate percent Application 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 loss Minimum differential List 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
