IUC Services Request Form

IUC SERVICES SURVEY FORM

PLATE HEAT EXCHANGER SERVICE

Please select the date for service
from the calendar
>>>>>>>>>>>>>>>>>>>>>>>>>>

10/29/2024

October 2024

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:

Plate Pack Service

Heat Exchanger Service

Will you send a sample plate?

Yes

Will you furnish drawings?

Yes

Turn Around Time Required
(work days):

Any other information we should have?