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