Customer Contact Information

First Name: * Last Name: * Title: Company: Address: *   City: * State: * AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutD.C.DelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code: * Country: USA E-Mail: * Day Phone: * Eve Phone:

	Powerblanket Application Questions

How will the Powerblanket(s) be used?* (Flat? Vertical? Wrap?)

Power Source Specifications* DC 12 voltsDC 13.5 voltsDC 24 voltsDC 48 voltsAC 120 voltsAC 240 volts(Other)

What is the enclosure?* (i.e. 55 gal. Barrel, 275 gal. Tote, etc.)

Dimensions of Enclosure?* (Diameter, Height, Width, Length)

Enclosure material type and thickness* (i.e. HDPE ½” thk, 304 SS ¼” thk, etc.)

Thermal Conductivity (W/mK)

Mass Density (kg/m^3)

Specific Heat (J/kgK)

Prints or 3-D electronic model(s) of enclosure available?

	Operating Environment Specifications
	(e.g. -20 degrees Fahrenheit, open exposure to 40 MPH winds, typically under a snowdrift, low probability of incidental contact/abrasion sources..)

Substance being heated

Vibration Environment

Maximum Velocity

Abrasion / Contact Area

Collest ambient temperature

Exposure to snow? Yes       No

Exposure to wind? Yes       No

	(This is important because different substances react to heat differently. If this information is unavailable, the calculations will be based on water.)

Thermal Conductivity (W/mK)

Mass Density (kg/m^3)

Specific Heat (J/kgK)

Spoil Temperatures for Substance

Incoming temperature of substance

Flow rate of substance in/out

Desired outgoing temperature of substance

	If There Is No In/Out Flow:

Coldest beginning temperature of substance

Final desired temperature of substance

Desired elasped time from start to finish

Explosion Class (C1D2?)

Immersed Probe? Yes       No

Surface Temperature Probe? Yes       No

UL/CSA required? Yes       No

	Specific Order Information

Do you have additional files/photos to send:

Specific Application Information:

Number of blankets (units) desired for first order?*

Desired delivery date for first order?*

Potential quantity/timing (#units/dates)?*