Name:

Company:

Address:

City: State:

Zip Code:

Phone:

Fax:

email:

Connection Type:
NPT
BSPT
BSPP
ANSI Screwed
ANSI Welded

Inlet/Outlet Type:
In Left - Out Right (Type 1)
In Top - Out Bottom (Type 2)
In Right - Out Left (Type 3)
In Bottom - Out Top (Type 4)

Registration:
Whole Gallon
10th Gallon
Litre
Pound

Seal Material:
Buna
Viton
Teflon
Kemraz
Other

Metered Product:

Product Temperature:

Viscosity @Working Temperature:

Max. Working/Surge/Shut-off Pressure:

Max. Flow Rate:

Min. Flow Rate:

Calibration Adjuster: Yes No

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Optional

Pulser:

Pulses Per Gallon/Litre:

Solenoid Valve Model Number, Size and Material:

Ball Valve and Linkage Size and Material:

Strainers Size, Material and Mesh:

Other Optional Items:

Factory Mounting and Wiring: Yes No