- To be used for new and replacement regulators

General Information

Date: Click or tap here to enter text.	Company: Click or tap here to enter text.

Contact Name(s): Click or tap here to enter text.

Email: Click or tap here to enter text.	Phone: Click or tap here to enter text.

Requested Delivery Date: Click or tap here to enter text.

Quantity: Click or tap here to enter text.

Tag number(s):	Click or tap here to enter text.

IF Replacing existing OR duplicating existing Regulator complete the following section:

Serial Number (not all regulators will have a serial number): Click or tap here to enter text.

OR

FS Number: Click or tap here to enter text.

OR

Product Number: Click or tap here to enter text.

AND

IF the regulator is pilot operated provide pilot info: Click or tap here to enter text.

New Regulator Application complete the following section:

Regulator Type (if known):	Click or tap here to enter text.

Fluid/Gas Type: Click or tap here to enter text.

Flow Rate/Capacity:	Click or tap here to enter text. Units: Click or tap here to enter text.

Regulator Body Size / Line Size: Click or tap here to enter text.

Inlet pressure: Click or tap here to enter text. Units: Click or tap here to enter text.

Outlet Pressure/Set Point: Click or tap here to enter text. Units: Click or tap here to enter text.

End Connection Type (NPT, Flat Face, Raised Face):	Click or tap here to enter text.

ANSI Class Rating (ie 150, 300) IF specified by customer: Click or tap here to enter text.

Temperature (So we can select internal materials): Click or tap here to enter text.

Material of construction if customer specifies: Click or tap here to enter text.