Date:

Customer:

Contact Person:

Contact Phone:

Final Product Destination:

E-mail:

PLIDCO+Flange Size:

Pipe O.D.:

Wall Thickness:

Working Pressure:

Material:

Max Design Pressure:

Temperature:

Pipe Content:

Packing Type:

Unanchored Pressure:

Anchored Pressure:

Flange Type:

ANSI

MSS-SP44

API

Other:  

Flange Face Type:

RF

FF

RTJ

LJ

Other:  

Pressure Class:

150#

300#

400#

600#

Other:  

Application:

Weld

Non-Weld

Underwater Usage?

Depth:

Installation:

External Forces?

Type and Magnitude:

Vents Required (Size/#)

Sealant Type

Provided Volume Required

Anode Required

Plated Studs & Nuts

White Marine Epoxy

Flange Gasket

Extra Clamp Screws

Extra Thrust Screws

Extra Packing

Lifting Eyes

Special Screw Material Required

Special Body Material Required

Material Certs Required

Special Tests Required

Quantity Required:

Delivery: