Automation Application Information *indicates required information
Company Name:		Contact Name:*
Address 1:		Phone #:
Address 2:		Fax #:
Email:*
General Application Statement:

Product Information

Valve to be Automated:

Type of Automation :

On/Off Modulating

Spring Return?: Positioner Required: I/P Solenoid Valve Mounting Pad Available:

Drawings of Valve attached? Available?: Air Supply available?: Filtration for air required?:

Component Delivery:

Automation items provided loose: Assembled: Mounted: Valve to be purchased: Free Issued:

Postioner Feedback Required? Type: Limit Switches? Visual Indicator?:

Power Available:

VDC:

Two Wire:

VAC:

Hz:

Type of Measurement:

Continuous (transmitter): Point (switch):

System Output Signal:

VDC:

mADC:

Digital:

Relay.

Characteristics

Housings:
Positioner/Feedback/Limit Switches:
Std: Nema 4: Nema 4x:

CL1 DIV 1: CL1 DIV 2: CL 2 Div 1: Cl 2 Div 2:

Instrinsically Safe:

Electronics:
Std: Nema 4: Nema 4x:

CL1 DIV 1: CL1 DIV 2: CL 2 Div 1: Cl 2 Div 2:

Ambient Temperature: Celcius Fahrenheight

Special Quoting Conditions:

Miscellaneous Details: