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 unit required	* Please select Bimetal Remote Reading Gas Temperature switch
Manufacturer (list any preference)
Model number (if known)
Quantity	*
Tag number - if required, list type & info
Fluid / Media	*
Temperature range - value and units	* * Please select Degrees F Degrees C
Dial size for thermometer	* Please select Not Applicable Size listed
Material of construction for housing	* Please select Phenolic Stainless steel Aluminum Plated / painted carbon steel Other - please list
Process connection	Please select 1/4" MNPT - Back 1/4" MNPT - Lower 1/2" MNPT - Back 1/2" MNPT - Lower 1/2" MNPT Adjustable angle Other - please list
Stem length / Insertion length	*
Stem / bulb diameter	* Please select 1/4" (standard for thermometer)) 3/8" (standard for switch) Other - please list
Thermowell	* Please select Yes, thermowell RFQ completed Yes, match to stem length listed No
Capillary length if remote mount	Please select Not applicable Yes
Switch point - req'd for switch	Please select Not applicable Increasing Decreasing Unknown
Deadband for switch point (if known)
Switch area classification	* Please select Not applicable NEMA 3 NEMA 4/4X NEMA 7 IP 65 IP 67 Other - please list Vendor select based on process
Switch element - voltage and current rating, number of contacts

Comments / Other available information / special requirements or considerations.
Remote reading style or remote switch application - list size of bulb and material, connection, housing material. 
If a capillary is required - list style, size and length.