All fields marked with an asterix (*) must be completed. Company Name* Contact* Job Title E-Mail Address* City* Province State* Phone Number* Fax Number Quantity Pipe Size (NPT) Valve Type 2-way 3-way 4-way Operation Normally Open Normally Closed Universal (3-way only) Body Material Brass Stainless Steel Media Air / Inert Gas Water Steam Other (specify below) Other Media Minimum Pressure (PSI) Maximum Pressure (PSI) Media Temp. °F (min-max) Ambient Temp. °F (min-max) Voltage (AC/DC) Enclosure General Purpose Explosion Proof Manual Operator Option Yes No Accessoriesor Notes
