NEWAlconComp-REV2 1/6/05 3:31 PM Page 1 Request For Quotation Fax Back Form Mailing Address: Address: Request For Quotation Company: Name: Address: City: Phone: Line Fluid: Air Line Pressure: (a) Inlet: (b) Downstream: (a-b) Maximum O.P.D. Minimum O.P.D. Supplier of valve Type: 2-Way 3-Way Pipe Size: NPT Flow: Cv Body Material: Brass Seal Material: Buna GPM psi psi psi psi Fax: State: Email: Zip: Complete this form and fax to: Alcon North America 1-716-662-0406 Please call us at: 1-888-307-0708 regarding your specific application or to request a catalog. Water Hot Water Steam Natural Gas Oil Minimum: Maximum: Other Gas or Liquid Ambient Temperature: ºF ºF Minimum: Maximum: ºF ºF Line Fluid Temperature: 5-Way Namur Orifice Size: Mode of Operation: Normally Open Normally Closed Universal psi SCFM Maximum Allowable Pressure Drop: Stainless Steel PTFE Other Viton DC Voltages EPDM Other Operating Voltage: AC Voltages (60Hz/50Hz) 24 VAC 120 VAC 220 VAC 12 VDC 24 VDC Other Power Consumption: Watts Electrical Connection: Conduit with Leads Industrial enclosure: NEMA 2 (Metal Can) Agency Approval: UL CSA DIN Other NEMA 6 (Hazardous Duty) Other NEMA 4 (Glass Reinforced Nylon) FM Other Make/Catalog number Number: Alcon Catalog Number: Make/Model of Current Valve now in service: Quantity Required: Single Shipment Annually Target Price ($): 1 Internet: www.alconsolenoids.com Phone: 1-888-307-0708 Fax: 1-716-662-0406