FMD PROVER DESIGN APPLICATION DATA SHEET Step 1 of 4 0% CUSTOMER INFORMATION Company* Contact Name* First Name Last Name Phone Number* E-Mail Address* Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country End User Engineering Firm Dealer Distributor Fabricator Consultant Quote Request Budgetary (pricing only) Standard Expedited (PO imminent) APPLICATION INFORMATION : Note: The meter information is required for correct selection of prover model. Meter Type Turbine PD Coriolis Ultrasonic Meter Size Model Number Process Fluid Flow Rate Operating Pressure Temperature Density Viscosity Installation Location Ambient Temperature Installation Climate On-Shore Off-Shore/Tropical Arctic Laboratory Prover Type Stationary Portable (i.e. Trailer or Truck-Mount) Agency Approval US/CSA ATEX IECEx Other Hazardous Area Classification PROVER DESIGN INFORMATION: Note: Please indicate any design preferences, otherwise FMD-standard will be used. Inlet/Outlet Flange Configuration RR LL RL LR TT 4A Other ANSI Flange Rating 150# 300# 600# 900# 1500# Flange Type (RF) Raised Face (RTJ) Ring Type Joint Motor Power Supply VAC Hz Phase VDC Hydraulic Tube Finish Wrap Natural Finish Water Draw Calibration Units Imperial (US) SI (Metric) Standard Calibration Conditions 60°F, 0 psig 15°C, 0 kPag Other OPTIONAL KITS Note: Please indicate any kits to be included in the quote. Spare Parts Kit Drain Kit Thermal Relief Kit Validation Kit Leak Detector Kit Shaft Seal Monitor Kit Insulation Kit PDAQ Kit Davit Crane Kit Density Kit Spectacle Blind Kit SPECIAL REQUESTS / ADDITIONAL INFORMATION Any special requests or any questions, please call FMD or your local representative for assistance. Completed by: Date: Comments This field is for validation purposes and should be left unchanged.
