Quotation Form

Company

Customer Name

Address 1

Address 2

City

State

Zip

Phone

Email Address

Model Type

Lens Material Lens MaterialHL-SSTC3"HL-SSTC4"

Connection Connection Clamp Weld Ferrule

Glass Type Glass TypeTempered BorosilicateTempered Soda LimeLexan

Ferrules Upper Ferrule Construction Ferrules Upper Ferrule Construction304316

Lower Ferrule Construction Lower Ferrule Construction304L316LHastelloy C-276Hastelloy C-22OthersNot Required

Gaskets GasketsEP - EPDMB - Buna NT - TeflonV - VitonNE - NeopreneSI - SiliconeOther

Wiper Wiper Yes No

Operating Pressure - PSIG

Operating Temperature - Deg F

Quantity

Special Instructions