Your Full Name: 

Company Name:

What is your type of business?  Select One Installer Contractor MFG Rep Wholesaler End User (Owner)

Address:

City: 

State or Province:

Zip: 

County:

Country:

Phone (Including Country Code if Applicable):

Fax:

Website URL:

Cell:

E-mail: 

Location where the equipment will be installed

Job Name:  

Bid Date: 

City: 

State or Province:

Zip

County

Country

Are there any Local, City, County, State or Country codes that you are aware of for this equipment?  

Electrical Requirements: 115V/60HZ/1PH 230V/60HZ/1PH 208V/60HZ/3PH 230V/60HZ/3PH 460V/60HZ/3PH 220V/50HZ/1PH 380V/50HZ/3PH 575V/60HZ/3PH (Volts/Cycle-HZ/Phase)

Will Feed System be:   Indoor    or   Outdoor  

What is the space available for the equipment in Feetor Meters ?

Height:

Width:

Length: 

Boiler size this system will serve (Max 450HP total) 1.5 3 7 9.5 10 15 20 25 30 40 48 50 70 90 115 150 200 250 300 350 400 450
(horsepower, LBS/HR, Kw, Kg/HR, Kcal/HR):

Number of Units: 1 2 3 4 5 6

MAWP of Boiler 15 100 125 150 200 240 250 Other PSI

MAWP of Boiler if not listed above:

Operating pressure PSIG 10% Below Safety Valve as a Minimum:

Job site elevation:Feet Meters

Are seismic restraints required? Yes  No

Do you want export crating?  Yes No

Any other special controls, trim, or insurance requirements.
  

Do you need any of the following;
Standby Pump?  Yes  No
Steam Sparger/preheater?  Yes  No
Pump starter mounted?  Yes  No
Pump starter shipped loose? Yes  No
Pump manual alternator?  Yes  No
Pump auto alternator?  Yes  No  
Hand off auto switch?  Yes  No
Disconnects mounted with starters?  Yes  No
Sacrificial anode rode?  Yes  No
Electric water fill in place of standard float type?  Yes  No
Any special Openings?  Yes  No

Please describe special openings or fax a sketch.

Sometimes if we know the application we can recommend options that will facilitate the use, installation and life of our products.

Please return this form with as much information as possible and we will get back with you as soon as possible.  

Domestic Inquiries

All units are delivered within 25 miles of our factory, Los Angeles, CA or domestic crated for common carrier.

International Inquiries

All international shipments are F.O.B. Factory, Los Angeles, California. Any export documentation, export crating, inland cartage, insurance or brokerage fees are not included. Currently our international terms are 30 % deposit prior to release for fabrication, balance cash in advance, electronic wire transfer prior to shipment. If you have any further questions about Parker Boiler please contact us at +1-323-727-9800.

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