AL-6XN Flow Transfer Panel Quotation Request

Please enter your contact information:
(*fields in gold are required)
*Name *Phone
*Company Fax
Title *Email
*Address
(line 1)		 Address
(line 2)
*City *State or Province
Country Postal Code
Type of Business If Other, specify
Industry If Other, specify
Add my email address to the Central States Industrial quarterly newletter mailing list 
Don't share my contact information with CSI's suppliers (I “opt out”) 
Please describe the panels you need:
Panel Quantity Needed:  Number of Jumpers/Panel: 
Port Size (tube OD): Port Connections:
If  Other, specify  Front If Other, specify
   Back If Other, specify
Port Layout:  If Other, specify 
Panel Size: Jumper Centerline Dimension (if required):
 Standard Dimensions  Standard Jumper Centerline
 Non-standard Dimensions (specify):    Non-standard Centerline (specify):
 
Proximity Switches (if needed): Proximity Switch Holes (if needed):
Size:  Quantity needed: 
Brand:  Hole size: 
Part#:   
Jumper Stem Size (if needed): Mounting Legs (if needed):
 None    None
 ½" Round Bar    Standard (1½" Sch. 10)
 ¾" Round Bar    Other (specify): 
   Include 6" x 6" base plates with       four anchor holes
Wall Sleeve/Frame (if needed): Drip Pan (if needed):
 None    None
 Standard (12 gauge)    Standard (12 gauge)
 Other (specify):     Other (specify): 
Nomenclature Labels (if needed): Materials of Construction:
  Non-wetted Surfaces: 
    Wetted Surfaces: 
Material Finish: Weld Finish:
20 Ra (180 grit) ID / 32 Ra (150 grit) OD ID: 
Other (specify): OD: 
ID:  (Polished weld finish is standard)
OD:   
Comments (you may enter up to more characters):