First Name
*
Last Name
*
Company Name
*
Phone
*
Email
*
Address
Address line 2
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Dist of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
This quote is for (please select)
Select
Chiller
Heat Exchanger
Other (specify below)
Equipment Quote for
Heat Load to be Removed
Required Coolant Temperature
This equipment will be (please select)
Select
Air Cooled
Water Cooled
If Water Cooled: Facility water flow available
If Water Cooled: Temperature Avail.
If Water Cooled: Pressure Avail.
Electrical Configuration
Voltage
Select
110 volts / single phase
208-230 volts / single phase
208-230 volts / 3 phase
460 / 3 phase
Other
Max Amps
Phase
Hertz (please select)
Select
50
60
50/60
Other Voltage
Special Electricial connection required? Please select.
Select
Yes
No
Are CE, UL, or CSA certifications required for this unit?
CE
UL
CSA
Cooling/Coolant Info
Ambient Air Temperature
Coolant Fluid
Coolant Flow Rate
Coolant Pressure
Coolant Temperature
Coolant Pressure Control
Filtration for Coolant? Please select.
Select
Yes
No
Coolant System is (please select)
Select
Open
Closed
Maximum Chiller Housing
Special Flow Meters Needed? Please select
Select
Yes
No
Do you require special controls, lights, relays, etc.?
Quote Info
Quote Quantity
Annual Production Requirement
Check all that apply
End User
OEM
Consultant
University
Other
Any additional information
*
indicates required fields