Name*			Address*
Title			Address
Company*			City*
Phone*			State*
Fax*			Zip*
E-mail*			Country*

Please fill in as many fields as possible - manufacturer standard options will apply unless directed otherwise. To submit the form for the quickest quotation the fields marked with ( * ) should be completed.  N/A, vendor select or unknown are acceptable inputs.  If you have any questions, please contact KECO at 732-901-5900 or keco@optonline.net.
Type of valve required	*Please select Vendor select based on conditions given Ball Globe images/butterfly 3-way Check Gate Safety / Relief
Type of control required	*Please select Modulating On / Off Diverting Converging / Mixing Safety Relief Not Applicable
Manufacturer (list any preference)
Model number (if known)
Quantity	*
Tag number - if required, list type and info
Fluid / Media	*
Specific Gravity (if known)
Inlet pressure List value, select units	Min:   *Norm: Max:   *Please select PSIG Inches H2O Kg/cm2 Bar Other - please list Not Applicable
Outlet pressure List value, select units	Min:   *Norm: Max:   *Please select PSIG Inches H2O Kg/cm2 Bar Other - please list Not Applicable
Safety / Relief Set pressure List value, select units	Please select PSIG Inches H2O Kg/cm2 Bar Other - list with value Not Applicable
Temperature List value, select units	Min:    *Norm: Max:    Please select Degrees F Degrees C Other - list with value
Flow rate List value, select units	Min:    *Norm: Max:    Please select GPM GPH SCFM SCFH lbs/min lbs/hr Other - please list
Required Cv (if known)
Body material	Please select Carbon steel 316 SS Cast iron PVC CPVC Other - please list
Body rating	Please select 150# 300# 600# 900# 1500# 2500# Other - please list
Connection	Please select Screwed RF Flanged Wafer Socket weld images/butt weld RTJ FF Flanged Other - please list
Inlet line size, schedule, material
Outlet line size, schedule, material if different from inlet
Internal trim material, i.e.: plug and seat, disc and shaft - type and material (if known)
Leakage ANSI class (if known)	Please select II III IV V VI Other - please list
Actuator	Please select Spring Diaphragm Cylinder Electric Electro-Hydraulic Spring Return Double Acting None - bare stem valve Other - please list Not Applicable List available air supply, power, etc.
Actuator action	Flow: Please select To Open To Close Not known   Fail Condition: Please select Open Close In Place Not known Air:    Please select To Open To Close Not known
Hand wheel	Please select Yes No Not Applicable
Positioner Please select Yes No Not Applicable	Action: Please select Direct Reverse      Gauges: Please select Yes No Input Signal: Please select 4-20 mA 3-15 psig Smart Other - please list Air Filter Regulator: Please select Yes No
I/P transducer Please select Yes, Valve mounted Yes, Remote mounted No Not Applicable	Action: Please select Direct Reverse Input Signal: Air Filter Regulator: Please select Yes No
Area classification	Please select General Purpose Explosion proof NEMA 4 / 4x NEMA 7 / 9 IP 65 IP 67 ASME coded for safety / relief valves Other - please list
Accessories - check all that apply, list any others	Stem position -   4-20 mA     Potentiometer Travel position switch - Open      Close

If possible, please list the application for which the valve will be used.  This will aid in properly selecting the correct valve.

Comments / Other available information / special requirements or considerations