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Engineering Request Form
Please take a moment to fill out our brief survey so we can better serve you,
General Information:
Company Name *
  Customer Name *
  Email
  Phone
  Fax
  Sales Rep
  Engineering Request Due Date
  JMS Part #
Inquiry Classification (check all that apply):
> General Technical Assistance
> Drawing Assistance / Review
> Material Specification
> Bid Technical Review
> Other (please expain)
Process Physical Characteristics:
  Tnom (in Degrees Farenheit)
  Tmax (in Degrees Farenheit)
  Vibration (in g/Hz)
  Pressure (in psi)
  Vflow (in ft/sec)
Chemical Environment:
> Oxidizing
> Reducing
> Inert
> Vacuum
  Process Chemistry (5-31, 33, 34)
  Electrical Classification (NEMA/IP Ratings, Isolated Intrinsically Safe Temperature Measurement Circuits, & Hazardous Locations)
* Required field