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

Product Information

Product to be Measured:

Specific Gravity:

Particle Size:

% Solids (by weight)

Viscosity:

Solution Slurry Single Phase

Line Size:

Thickness or Sched: Pipe Material: Lining:

Measurement Range

Units

Process Range

(MIN)

(NOM)

(MAX)

(MIN)

(MAX)

Flow Rate:

Fluid Pressure:

Fluid Temperature:

Flow Conditions:

Instrument Connections

37 Degree Flare Tube Wafer MNPT Threads; Size

Flanged; Flange Rating: ANSI DIN Other

Acceptable Wetted Material:
Corrosion/Erosion Effect:
Flow Conditions (steady, pulsating, etc.):

Accuracy Required: Linear: Non Linear:
Turndown: Repeatability:

Function:
Control: Indication: Alarm:
Data Log: Mass Flow: Totalizing:
Batching: Flow Computing:

Power Available:

VDC:

Two Wire:

VAC:

Hz:

Type of Measurement:

Continuous (transmitter): Point (switch):

System Output Signal:

VDC:

mADC:

Digital:

Relay.

Linear with flow: Standard flowmeter:

Characteristics

System Display:
None: Setup Meter: Indicating Meter:
Digital, 3 1/2 Digits: Other Local: Remote:

Housings:
Flowmeter:
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:

Mounting:

Wall Mounted: Rack Mounted: Panel Mounted:

Ambient Temperature: Celcius Fahrenheight

Special Quoting Conditions:

Miscellaneous Details: