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    Name Job Title/Position
    Telephone Number Email
    Company Name
    Address

    Part Number (if available):

    Required Delivery / Due Date:

    Quantity:

    Inside Diameter (ID): Face to Face (FF) Dimension:

    Expansion Joint: Single ArchMultiple ArchLightweightOther

    Concentric Reducer: ID x ID x Face to Face Length
    Eccentric Reducer: ID x ID x Face to Face Length

    SleeveEnlarged FlangeFilled ArchOpen Arch

    Flue Duct / Fan ConnectorPump

    Cover Material: Color:
    If "Other" specify:

     

    Tube Material: Color:
    If "Other" specify:

     

    No. of Open Arches: No. of Filled Arches:

     

    1st Flange OD: OD 150 LBS300 LBSOther

     

    2nd Flange OD: OD 150 LBS300 LBSOther

     

    Split Metal Retaining Rings: YesNo Type: Stainless SteelCarbon
    # of Ring Sets: Size of Rings:

     

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