23 Distributor Information Distributor Name/Contact Person:____________________________________________________________________________ Customer Information Customer Name: ________________________________________________________________________________________ Customer Address: ______________________________________________________________________________________ Contact Name/Telephone: _________________________________________________________________________________ LCMag Ordering Worksheet Rate of Flow (GPM): Rate of Flow (L/min): System Pressure Range (PSI): System Temperature Range (°F) Min. __________________ Min. __________________ Min. __________________ Min. __________________ Max.__________________ Max.__________________ Max.__________________ Max.__________________ Normal: _______________ Normal: _______________ Normal: _______________ Normal: _______________ Process Fittings (flanged, wafer, threaded, or sanitary): _____________________________________________________________ Pulse Output per Unit: _____________________________________________________________________________________ ( pulses per unit must not exceed 1.25KHz at max flow or 10KHz with Converter Option “D”, High Frequency Output) Desired Display (if specified on converter) Analog Output Range: Supply Voltage: _________________ Converter Location: Length of Cable Required: _________ ft Totalizer Units: _________________ ( full gal., 1/10 gal, etc.) 0-20 mA or 4-20 mA 0 or 4mA: min. scale _____________ 20 mA: full scale ________________ Integral: ______________________ Rate of Flow Units: ______________ ( full GPM, 1/10 GPM, etc.) GPM GPM Remote: ______________________ Date: ___________________ Application Data Meter to be used for: Rate of Flow Indication: _____________________________ Totalization:______________________________________ Batching: _______________________________________ Process Control: __________________________________ Other: __________________________________________ Product (process fluid): _____________________________ Conductivity of Product (5μS/cm minimum): ______________ Suspended Solids in Product? ________________________ Abrasive Fluid? ___________________________________
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