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Date:

Customer:

Contact Person:

Contact Phone:

Final Product Destination:

E-mail:

Temperature:

Flange+Repair Size:

Working Pressure:

Max Design Pressure:

Flange Content:

Packing Type:

Flange O.D.:

Flange (1) Thickness:

Gap:

Flange (2) Thickness:

Circumference:

Flange Type:

Bonnet

Run

Other:  

Flange Face Type:

RF

FF

RTJ

LJ

Other:  

Pressure Class:

150#

300#

400#

600#

Other:  

Underwater Usage?

Depth:

Installation:

Vents Required (Size/#)

Sealant Type

Provided Volume Required

Anode Required

Plated Studs & Nuts

White Marine Epoxy

Extra Studs & Nuts

Hinges Required

Alignment Tabs

Extra Packing

Vent Covers

Special Materials Required

Material Certs Required

Special Tests Required

Quantity Required:

Delivery: