All fields marked with an asterix (*) must be completed.

Company Name*
Contact*
Job Title
E-Mail Address*
City*
Province State*
Phone Number*
Fax Number
Horsepower
RPM
Voltage
Phase
 Single Phase Three Phase
Hertz
Configuration
Frame
Enclosure
 ODP TEFC Explosion Proof
If Explosion Proof
Area Classification
 Class I, Division I Class I, Division II
Inverter Duty?
 Yes No
If Inverter Duty Constant Torque Variable Torque
Turndown Ratio
Thermistors?
 Yes No
Heaters?
 Yes No
Other Requirements