Name:

 

Company:

 

Street Addr. 1:

 

Street Addr. 2:

 

City/Town:

 

State/Province:

 

Zip/Postal Code:

 

Phone:

 

Fax:

 

Email:

 

Cooling Application Information

Equipment:

 Equipment to be cooled

Quanity Required:

 

Date Required:

 

Active Heat Load:

 Active Heat Load (Btu/hr or Watts)

Coolant Type:

 Coolant Type (Water, Glycol, PAO, etc.)

Flow Rate:

 Coolant Flow Rate

Supply Pressure:

 Coolant Supply Pressure at Rated Flow

Max. Pressure:

 Coolant Maximum Pressure to Equipment (Blocked Discharge/No Flow)

Connections:

 Coolant Connections

Supply Temp:

 Coolant Supply Temperature

Max. Return Temp:

 Coolant Maximum Return Temperature

Purity Spec:

 Coolant Purity Specifications (If Applicable)

Filtration:

 Filtration (Particulate, Deionizer, Oxygen Removal, If Required)

Cooling Method:

Unknown CU - Liquid-to-Air, Non-refrigerated CUW - Liquid-to-Liquid, Non-refrigerated RU - Liquid-to-Air, Refrigerated RU - Liquid-to-Air, Refrigerated Split System RUW - Liquid-to-Liquid, Refrigerated RC - Air Circulating/Cooling Unit  

Input Power:

 Prime Input Power (Voltage, 1 or 3 Phase, Frequency)

Indoor/Outdoor:

 Environment - Indoor/Outdoor (Sheltered/Non-Sheltered)

Operating Temp:

 Environment - Ambient Operating Temperature (Min-Max Range)

Storage Temp:

 Environment - Ambient Storage Temperature (Min-Max Range)

Special Conditions:

 Special Environmental Conditions (Airborne, Shipboard, Coastal Proximity, Altitude, etc.)

Mounting:

 Mounting (Casters, Mounting Channels/Skids, Rack Mount, etc.)

Noise Limits:

 Noise Limits (If Applicable)

Instrumentation:

 Instrumentation (Gauges, Indicators, Flow Meter, etc.)

Interlocks:

 Interlocks (Flow, Temperature, Level, etc.)

Additional Specs:

 

 

Please complete form. When complete - Either:

A. Click "Submit" to send email request with info. to:

- Or -

B. Click "Print" to print form and Mail / Fax to Electro Impulse, Inc.; Attn: Applications Engineer