Information Request Form

FM618 Order Request Form

Bill to:

Name
Company
Address
City
State/Province
Postal Code		Country
Telephone
FAX
E-mail

Ship to:

Name
Company
Address
City
State/Province
Postal Code		Country
Telephone
FAX
E-mail

Base Model #:

Size:

Electrode Material:

Transmitter Options:

End Connections:

Transmitter Mounting:

Power Supply:

Special Options:

Grounding Rings:

Application Information (required to process your order):

Liquid:

Min Conductivity (micromhos):

Temperature: Min:     Max:

Pressure: Min:     Max:

Calibration Information:

Full Scale Flow Rate @ 20 mA:

gpm

lpm

other

Volume/Pulse
(only with display option and if pulse output is required)

Purchase Order #:

Required Date (standard delivery time 2-4 weeks):

Payment Terms:

Shipment Terms:

If charging to a Credit Card #, please give phone # where we can contact you:

Questions/Notes:

If you have any ordering questions please call (626) 444-0571 x234 or email sales@sparlinginstruments.com.

Or fax information to (626) 452-0723.