Your Full Name: 

Company Name:

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

Address:

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Zip: 

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Phone (Including Country Code if Applicable):

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Location where the equipment will be installed

Job Name:  

Bid Date: 

City: 

State or Province:

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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)

Is boiler:   Indoor    or   Outdoor  

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

Height:

Width:

Length: 

Fuel specifications

Type of Fuel: Natural Gas, 950-1100 BTU cu. ft. W 7-14" W.C. Inlet Pressure Natural Gas, 950-1100 BTU cu. ft. W 1-5 PSI Inlet Pressure Propane or LPG, 2500-3500 BTU cu. ft. W 1-5 PSI Inlet Pressure Combination #2 Oil-Diesel/Natural Gas  W 7-14" W.C. Inlet Pressure Combination #2 Oil-Diesel/Propane W 7-14" W.C. Inlet Pressure, Gas Combination #2 Oil-Diesel/Natural Gas W 1-5 PSI Inlet Pressure, Gas #2 Oil-Diesel, 141,000 BTU/GAL

Do you need a standby fuel?  If so, what type?
None Natural Gas, 1050 BTU cu. ft. Propane or LPG, 2500-3500 BTU cu. ft. #2 Oil-Diesel, 141,000 BTU/GAL

Boiler model: Unknown T-160 T-220 T-300 T-395 T-490 T-600 T-760 T-970 T-1140 T-1460 T-1730 T-1995 T-2160 T-2600 T-2970 T-3600 T-3900 T-4600 T-5700 T-6800 *-432 *-528 *-672 *-864 *-1008 *-1296 *-1536 *-1920 *-2304 *-2640 *-3120 *-3456 *-4032 *-5000 *-6250 - To find boiler model;
If type of fuel is Natural gas or propane only refer to table with T-models
If type of fuel is #2 oil or combination refer to table with *-models

Number of Units: 1 2 3 4 5 6

Safety valve setting: 30 45 50 100 125 150 200 250 300 Other PSI

Special Safety valve setting if not listed above:

What is the operating temp? (130 - 400°F)

Operating pressure PSIG 25% Below Safety Valve as a Minimum:

Job site elevation:Feet Meters

Is a low emission boiler required? Yes   No

Emission Level Required NOx: N/A 9 12 20 30 60 100 PPM, CO: N/A 100 400 1000 PPM (check with local air district)

Are seismic restraints required? Yes  No

Do you want export crating?  Yes No

Any other special controls, trim, or insurance requirements.
  

How many hours per day will the boiler operate?:

Do you need any of the following;
Circulating pump?  Yes  No
Standby circulating pump?  Yes  No
Pump starter with heaters loose?   Yes  No
    Flow GPM at HD
Expansion tank?  Yes  No
    What is the system volume in gallons?
Air separator?  Yes  No
Pot chemical feeder?  Yes  No
Any special temperature controls?

Is there any additional information you can provide?

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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