Customer Name: Address: City: State: Zip: Phone: Fax: E-mail Address: Contact: 1. Description of application (include type of equipment plus description of system): 2. Overall dimensions in inches: Length X   Width 3. Material thickness: 2 Ply (0.08") 4 Ply (0.16") 4. Heater requirements: Volts:        Watts:         Phase: 1 3 5. Temperature sensor: RTD T/C J T/C K Other Sensor    Qty:     6. Required leadwire length: Inches 7. Misc. notes:

© 2005 The Conrad Company. All rights reserved • Phone: 614-864-3971 • Fax: 614-759-4912 • Email:  sales@conrad-co.com