Oxygen Generation - Online Inquiry Form

Phone: 1-519-737-7760 ~ Fax: 1-519-737-6944 ~ Toll Free: 1-877-737-7760

(Please fill in the details and then click the "Submit" button)
Note: this function only works with Microsoft Internet Explorer, if using Netscape please fill in the details, print this page and fax us your request.

OXYGEN SYSTEM REQUIREMENTS FORM

With this handy form, you can provide us with the information we need to specify the right oxygen generating system for your application.

Date:	(mm/dd/yy)
Name:
Company:
Address:
City:
State/Province:	Zip Code:
Country:
Telephone:
Fax:
E-Mail:
How did you hear about GENEROX® Systems? Google Yahoo Other OXYGEN REQUIREMENTS:
Hourly Flow:	scfh or Nm³ / hr
Minimum Oxygen Pressure:	psig or Barg
Operating Purity:	% Oxygen
Required Delivery Date:	(mm/dd/yy)
Plant Location:
Application:
FACILITY INFORMATION:
Hours/Day:	hour(s)/day
Days/Week:	day(s)/week
SUPPLY VOLTAGE: (choose one) 480 volt, 3 phase, 60hz 415 volt, 3 phase, 50hz 380 volt, 3 phase, 50hz Other:volt, , hz AMBIENT TEMPERATURES:
Minimum:	degrees F or degrees C
Maximum:	degrees F or degrees C
Design Temperature:	degrees F or degrees C
Site Elevation:	ft.(1,000 ft.Standard) or m.(300 m.Standard)
Design Humidity:	%
CURRENT CONSUMPTION INFORMATION (if applicable)
Source
Application
Flow Rate
If you DO NOT KNOW your flow rate, please tell us: How many (enter number) per do you use?
Is gas consumption continuous?
If "no", what is the surge flow rate: How many (enter number) SCFH or NM³/hour

Other Information

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Phone: 1-519-737-7760 ~ Fax: 1-519-737-6944 ~ Toll Free: 1-877-737-7760

OXYGEN SYSTEM REQUIREMENTS FORM

OXYGEN REQUIREMENTS:

FACILITY INFORMATION:

SUPPLY VOLTAGE: (choose one)

AMBIENT TEMPERATURES:

CURRENT CONSUMPTION INFORMATION (if applicable)

Other Information