CONTROL PANEL REQUEST FOR QUOTATION YOUR COMPANY INFORMATIONCompany NameAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Contact NameEmail Phone/ExtFaxContact Name 2ndEmail Phone/ExtFaxCompany PhoneCompany FaxSYSTEM INFORMATIONBasic Description Of Heating ProcessWeather EXPOSUREIndoorOutdoorIndoorYesNoOutdoorYesNoControlled ENVIRONMENTControlledUncontrolledControlledYesNoUncontrolledYesNoNEMA Enclosure Type RequestedVOLTAGE Requirement (Supply)120vac240vac480vacOTHEROTHERVOLTAGE Requirement (Controls)120vac240vac24vacPHASESINGLETHREENumber Of ZONES123456OTHERTemperature Range RequirementLOWHIGHMaterial To Be HeatedFLUIDSOLIDGASMaterial DescriptionHEATER TypeBand HeaterCartridge HeaterCirculation HeaterImmersion HeaterRadiant HeaterStrip HeaterTubular HeaterOther Heater TypeAdditional Requirement(s):Pilot Light(s) RequirementYESNOHigh Limit RequirementYESNOSINGLEPER ZONEALARM RequirementYESNOVISUALAUDIBLEDisconnect Switch RequirementYESNoLOCKINGDisconnect Switch Requirement TYPEFusedUnfusedBreakerCONTROLLER Type RequestedEZPMRM SeriesF4 SeriesOTHEROtherCOMMUNICATIONSStd.BusRS484 (PM)MODBUS 485RS232/485EthernetIs Close Control Of Temperature Required?YesNoPOWER ControlSolid State RelayDin-A-MitePower SeriesQPAC OTHERShorted SSR ALARM?YESNOSINGLEPER ZONEADDITIONAL INFORMATION
