Contact Information
Name:	(required)
Company/Customer:	(required)
Position:	(required)
Email:	(required)
Telephone:

Application Information
Valve Function:	Select One Control Valve On/Off Valve Isolation Valve		Valve Size:
Valve Type:		Select One Ball Butterfly Cryogenic Safety/Relief Other
Line Size/Schedule:
Pipe Material:
Description of Application:
Materials of Construcion: Body: Trim: Seats:
End Connection Configurations: Select One FNPT RF150 RF300 RF600 RF900 RF1500 Other:

Inlet Pressure:
Outlet Pressure:
P:
Flow Rate:   Max Min Normal

Max. Temp.:		Min Temp.:
Max. Operating Differential Against Which the Valve Must Open or Close:
Media:  Condition: Dirty Clean Abrasive Corrosive Select One

Specific Gravity:
Vapor Pressure
Will/Can Valve Be Insulated:	Select One Yes No

Actuator Information
Type of Actuator Requested:	Select One Pneumatic Electric
Fail Direction:	Select One Open Closed Last Position
Power Supply to Actuator:
Available Air Supply Pressure: