Split+Sleeve
Order Information Form
* = required field
Date
Customer
Contact Person
*
Contact Phone
*
Final Product Destination
*
E-mail
*
Sleeve Size
Pipe O.D.
*
Temperature
*
Working Pressure
*
Wall Thickness
Max Design Pressure
*
Material
Packing Type
Pipe Content
*
Length Between Seals
Belly Diameter
Application:
Weld
Non-Weld
Rows of Packing:
Single
Double
Underwater Usage?
Depth
Installation:
Vertical
Horizontal
External Forces?
Type and Magnitude
Vents Required (Size/#)
Sealant Type
Provided Volume Required
Anode Required
Plated Studs & Nuts
White Marine Epoxy
Extra Studs & Nuts
Hinges Required
Sling Closures
Extra Packing
Vent Covers
Special Materials Required
Material Certs Required
Special Tests Required
Quantity Required
Delivery:
Standard
PPT
Remarks
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