Thermowell Request Form

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.
Manufacturer (list any preference)
Model number (if known)
Quantity *
Tag number - if required, list type and info
Fluid / Media to be measured *
Temperature range-value and units *
Type of process connection
Process connection size

1/2" FNPT element connection standard, list if other

Bore Size
Shank style
Insertion length - please list *
Lag extension - if required
Material of construction

Comments / Available information / special requirements or considerations

Thank you for contacting Keco Engineered Controls
1200 River Avenue Bldg. 3A   Lakewood, NJ 08701-5657
Phone: 732 901-5900 Fax: 732 901-5904
E-mail: keco@optonline.net Website: www.kecocontrols.com