RARITAN VALVE & AUTOMATION, INC. Quotation Request

SERVICE
Pressure:
Temperature:
Media
Flow:
Describe Service:

Notes/Comments:
VALVE
Quantity:
Size		If Special:
Valve Type:		If Other:
Preferred Materials of Construction
Body:		If Other:
Trim (Ball, Disc, Plug):		If Other:
Seat/Seal/Sleeve:		If Other:

End Connections:		If Other:
Pressure Class:		If Other:

Operator:		If Other:

Notes/Comments:
ELECTRIC OPERATOR DATA - Fill out if Electric Operator was selected above
Enclosure:		If Other:
Voltage:		If Other:
Control Options:		If Other:
Other Options: Select all required
Heater & Thermostate:		Position Feedback (4-20ma):
Brake:		Local/Remote Control Selector:
Auxiliary Limit Switch(s):	Qty:	Mechanical Travel Stops:
Potentiometer:		De-Clutch Handwheel Override:

Notes/Comments:
PNEUMATIC OPERATOR DATA - Fill out if Pneumatic Operator was selected above
Action:
Air Supply:		If Other:
Control Options:		If Other:
Controls NEMA Rating:
Other Options: Select all required
Limit Switch(s):	Qty:	Nema Rating:
Position Feedback (4-20ma):		Nema Rating:
Mechanical Travel Stops:
De-Clutch Handwheel Override:

Notes/Comments:
REQUESTED BY
Name (required):		Title:
Company:
E-Mail (required):		Fax:
Telephone:
Address:
City:
State:
Zip:

Notes/Comments:

NOTE: A copy of this form will be e-mailed to you for your records.