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:

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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)

Is boiler:   Indoor    or   Outdoor  

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

Height:

Width:

Length: 

Boiler model: WH300 WH395 WH490 WH600 WH730 WH970 WH1210 WH1410 WH1900 WH2270 WH2650 WH3000 Refer to table below

Number of Units: 1 2 3 4 5 6

Safety valve setting: 15 30 100 125 150 200 240 250 Other PSI

Special Safety valve setting if not listed above:

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)

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

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;
Storage tank Vertical or Horizontal
    How many gallons? (15-2500)
    Do you want interior tank lining?  Yes  No
    Circulating pump to and from tank?  Yes  No
    Sacrificial anode in tank? Yes  No
    T & P gauge for tank? Yes  No
    T & P relief valve for tank?  Yes  No
Sacrificial anode in heater?  Yes  No
Packaged piping kit?  Yes  No  
Standby Pump?  Yes  No
Combination service primary closed loop and open system heater 316 stainless steel heat exchanger? Yes  No

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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