Electronic Form

Customer Information

Customer Name:


Street Address:

Address (cont.):



Zip Code:


Work Phone:


Email Address:

Boiler Information

Plant Location:

Type of Boiler:

(i.e., "D", "O", Field Erected, etc.)


Boiler Manufacturer & Model No.:

Boiler Heating Surface - Ft2:

Furnace Dimensions:

(setting dwg. preferred if available)


Present Type & Quantity of Burner:

Does the Boiler have an Economizer?

Does the Boiler have an  Airheater?

If yes, what is the Outlet Gas Temp., °F?

Pounds of Steam Per Hour - Maximum:

Pounds of Steam Per Hour - Minimum:

(Turndown Normal on gas = 10:1, On Oil = 8:1)
(Extended Turndown Available)


Operating Steam Pressure - PSIG:

Steam Temperature, °F:

Feedwater Temperature, °F:

Furnace Pressure @ Full Firing Rate, Inches W.C.:

Plant Elevation - Ft. Above Sea Level:

Type of Installation:

Combustion Air Temperature, °F:

(Normal = 80 °F)


Fuel Type (Gas) - @BTU/Cu. Ft.:

(Natural Gas = 1000; Propane = 250)


Gas Main Plant Header Pressure - PSIG:

Regulation of Gas Pressure to Gas Train By:

Gas Pressure Available to Gas Train - PSIG:

Fuel Type (Oil):

Type Atomization Preferred:

Electric Current for Motors:

(Volt, Phase, Hertz)


Electric Current for Controls:

(Volt, Phase, Hertz)


Type Operation:

Type Combustion Controls:

Combustion Controls Furnished By:

Insurance Requirements:

Type of Proposal Required:

(i.e., Budget, Close Budget, Firm)


NOx Emission Level Required:

(ppm or LB/MMBTU)


Required Shipment Date for Equipment:


Should Freight be included in the Base Price?  

Yes  No
(FOB Lock Haven, PA with freight prepaid & included)


Additional Comments:


NOTE:  If fuel is not a standard, such as natural gas, propane, No. 2 oil or No. 6 oil, or if NOx reduction is required, a detailed analysis will be required.


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