New Valve Quote Form Cover Sheet

** This Cover Sheet must be filled out in its entirety in order to receive a quotation. **

Please provide the following information about the valve application:

End-User Name: Mailing Address*: City / State / Zip Site Contact Name: Telephone: Valve Application / Industry:

* This information is for Solution Valve records only and will not be divulged to outside parties.

Note: The Specification Sheet following this cover sheet is a universal form. Not all information will be necessary for every application. Valve Specification Sheet

Date: Phone Number: Customer: Fax Number: Mailing Address: Project: City / State / Zip: RPT Representative: Solution Valve Contact Name: Email:

Please Fill In All That Applies

General Application Type Is this a Pressure Relief or Emergency Pressure Isolation Application? In-Line or Angle flange pattern required? Will the valve inlet be oriented vertically or horizontally with respect to the ground? Is this valve identical to a valve you’ve ordered previously? If so, please list the serial number of the previous valve.

Service Conditions

Normal Operating Pressure: Units PSIG Max. Operating Pressure: Units PSIG Normal Operating Temperature: Units °F Min/Max. Operating Temperature: Units °F Max Flowing Temperature: Units Constant Back Pressure: Units Variable Back Pressure Range: Units Allowable Overpressure: % (10% is Standard) Molecular Weight: Specific Gravity: Units Viscosity at Flowing Temperature: Units Compressibility: Units Ratio of Specific Heats: Required Relieving Capacity: Units Name of Gas or Fluid Components:

Is your application corrosive? Is your application abrasive? Valve Specifications Valve Set Pressure: Units PSIG Inlet Line Size: Inlet Connection Type: (NPT, RF, RTJ, Hammer, Etc.) Inlet Connection Rating: (ANSI 150#, 1502, Etc.) Outlet Line Size: Outlet Connection Type: (NPT, RF, RTJ, Hammer, Etc.) Outlet Connection Rating: (ANSI 150#, 1502, Etc.) Materials of Construction Standard Options for Materials Body CS, Low-Temp CS, SS Seat SS Piston SS with 17-4 SS Stem Gland Bushing Aluminum Bronze, SS Seals Viton, Buna, Kalrez, EPDM Clean Service Finish Required?

Additional Cost Options Yes or No Yes or No Proximity Switch Pin Storage on Valve Pin Cage Protector Spare Pins (QTY) Special Tagging Special Paint Special Dimensional Additional Requirements Documentation 100% NDE Material Test Reports Chart Recorded Shell Replacement of Lost Test Documentation Unlisted Option Request  Please describe the unlisted option that you want

Additional Comments