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IUC SERVICES SURVEY FORM
PLATE HEAT EXCHANGER SERVICE
Please select the date for service
from the calendar
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                7/24/2024
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Client Company: 
Contact Person:     Job Title:
Phone:    ext.     FAX: 
Mailing Address:
Address 1: 
Address 2: 
City:     State:   Zip: 
Salesperson Name: 
 
***********  UNIT INFORMATION ***********
Manufacturer:      Model: 
Year Made:    Serial Number:    Quantity of Plates:   
Plate Material and Thickness:    
Gasket Material: 
Gasket Part Numbers: 
Design:  PSIG @  Degrees 
Unit Weight:   Number of Passes:
Item No.:    Describe Process:
Describe Problems:
 
**************  SERVICE REQUESTED **************
(REFER TO POLICY STATEMENT FOR DEFINITIONS)
 
Type of Service Needed:  
Will you send a sample plate?  Will you furnish drawings? 
 
Turn Around Time Required
(work days):
Any other information we should have?
 (REFER TO POLICY STATEMENT FOR DEFINITIONS)