PSI / Pikotek Casing Spacer Request For Quote (RFQ)

Please provide your application information in chart and MDG will respond with estimated pricing.
(Pricing will be established based on standard sizing as calculated by MDG)
If you would like a copy of the information supplied, please print file before submitting form.

Contact Name:		Date:
Company		Telephone:
Email:
Project Information
Project Name:
Location:
City/State/Zip:
Engineer:
Bid Date:
Award Date:
Attn.:

Metallic Casing Spacers/Isolators
QUANTITY OR LENGTH OF RUN		NUMBER OF INSERTIONS	SPACER TYPE	BAND WIDTH	RUNNER WIDTH*	ACTUAL CARRIER PIPE O.D.	ACTUAL CASING PIPE I.D.	ACTUAL BELL OR JOINT O.D.	POSITION IN CASING	PRICE Provided by MDG
	Qty. Length
	Qty. Length
	Qty. Length
	Qty. Length

End Seals:		Filled Casing:
Comments:

Non-Metallic Casing Spacers/Isolators
QUANTITY OR LENGTH OF RUN		NUMBER OF INSERTIONS	SPACER TYPE	ACTUAL CARRIER PIPE O.D.	ACTUAL CASING PIPE I.D.	ACTUAL BELL OR JOINT O.D.	POSITION IN CASING	PRICE Provided by MDG
	Qty. Length
	Qty. Length
	Qty. Length
	Qty. Length

End Seals:		Filled Casing:
Comments: