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Standard	Non-Standard
Date:	From:
Title:	Company:
Address:	Phone No:
Drawing attached:YesNo	E-mail Address:
Attachment (Max file size - 5MB):	Fax No:
Application
Pipe FlangePumps - centrifugal/horizontal split caseHeat ExchangerFlue DuctManwayValve BonnetCompressorCompressor
Other:
Service Conditions
Maximum Temperature: (°F/°C)	Continuous Operating Temperature: (°F/°C)
Internal Pressure: (psig/bar)	PSIG/bar : ContinuousIntermittent
Thermal Cycling: (24 hours)	Vibration: YesNo
Other (specify):
Bolts
Grade:	Diameter:
Length:	Number:
Chemical Compatibility
Media:	pH:
Concentration:	Liquid or Gas:
Flange
Material:	Material:
Size:	I.D./O.D. :
Rating:	Flange Thickness:
Surface Finish: RMS	Bolt Circle Diameter:
PhonographicConcentric	Surface Finish: RMS
Face (raised, flat, tongue & groove, etc.):	PhonorphicConcentric
	Face (raised, flat,tongue & groove,etc.):

Application