Date:

Customer:

Contact Person:

Contact Phone:

Final Product Destination:

E-mail:

Weld + End Size:

Wall Thickness:

Pipe O.D.:

Pipe Material:

Pipe Content:

Packing Type:

Length Between Seals:

Operating Temperature:

Working Pressure:

Max Design Pressure:

Pipe Anchored Pressure:

Pipe Unanchored Pressure:

Application:

Installation:

Clamp Screws:

Line Pressure Prior To Welding:

Line Pressure During Welding:

Line Pressure After Welding:

Underwater Usage (depth):

External Forces (Type and Magnitude):

Lifting Eyes:

Anode Required:

Plated Screws:

White Marine Epoxy:

External Thrust Screws:

Extra Packing:

Extra Clamp Screws:

Time Frame Of Project:

Special Body Material Required:

Special Screw Material Required:

Material Certs Required:

Special Tests Required:

Quantity Required:

Delivery:

Remarks: