FMD PROVER DESIGN APPLICATION DATA SHEET "*" indicates required fields Step 1 of 4 0% CUSTOMER INFORMATIONCompany* Contact Name* First Name Last Name Phone Number*E-Mail Address* Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country End User Quote TypeChoose OneBudgetary - Pricing OnlyStandardExpedited (PO Imminent)Anticipated Need Date MM slash DD slash YYYY APPLICATION INFORMATION :Note: The meter information is required for correct selection of prover model.Meter TypeChoose OneStandard TurbineHelical TurbineCoriolisPDUltrasonicMeter Size Line Size Model Number Process Fluid Flow Rate (Per Meter)Min Nom Max UnitsChoose OneGAL/MINBPHM3HLPHDensityMin Max UnitsChoose OneSGUAPIKG/M3LB/FT3Operating PressureMin Max Design UnitsChoose OnePSIBarkPaMPaViscosityMin Max UnitsChoose OnecPcSTSSUmPasTemperatureMin Max Design UnitsChoose OneDegress FDegress CInstallation Location-- Ambient Temperature (Install Location)MinMaxInstallation Destination (City, State, Country) Installation ClimateChoose OneOnshoreOffshoreTropicalArcticLaboratoryProver TypeChoose OneStationaryPortable – Truck/Trailer MountAgency ApprovalChoose OneUS/CSAATEXIECExHazardous Area ClassificationChoose OneUS/CSA Class 1 Div 1 40 Degrees CUS/CSA Class 1 Div 2 40 Degrees CATEX Ex d mb [ia] IIB T3 Gb -20 to 40 degrees CIECEx Ex d mb [ia] IIB T3 Gb -20 to 40 degrees COther - Please Contact Factory PROVER DESIGN INFORMATION:Note: Please indicate any design preferences, otherwise FMD-standard will be used.Wetted Materials 304 SS 316 SS Inlet/Outlet Flange Configurations Please Note: RR, LL & TT are standard Flange Configurations and may have a shorter lead time.Please Note: RR, LL & TT are standard Flange Configurations and may have a shorter lead time. Flange Configuration Drawing RR (Right Right) LL (Left Left) TT (Top Top) RL (Right Left) LR (Left Right) 4A (Right Left Right Left) Other - Please specify ANSI Flange Rating 150# 300# 600# 900# 1500# Most FMD Prover models have Duplex SS flanges which meet the carbon steel pressure rating for ANSI/ASME codes. Contact Factory for low-temp or cryo application exceptions. Flange Type (RF) Raised Face (RTJ) Ring Type Joint Pressure Class ANSI PED Prover Power SupplyChoose One24 VDC - Prover Models #'s FMD007 to FMD060 - US/CSA Classification only220/230/240 VAC 1ph 50Hz - Prover Model #'s FMD-007 to FMD-090190/220 VAC 3ph 50Hz - Advise Delta or Wye Configuration380/400/415 VAC 3ph 50Hz - Advise Delta or Wye Configuration110-120 VAC 1ph 60Hz - Prover Models #'s FMD-007 to FMD-090 - US/CSA Classification only220/230 VAC 1ph 60Hz - Prover Model #'s FMD-007 to FMD-090208-230/240 VAC 3ph 60Hz - Advise Delta or Wye Configuration440/460/480 VAC 3ph 60Hz - Advise Delta or Wye ConfigurationProver Power Supply Comments Tube Finish Wrap Natural Finish Water Draw Calibration UnitsChoose OneImperial (US)SI (Metric)Standard Calibration ConditionsChoose One60 F - 0 psig15 C - 0 Kpag20 C - 0 Kpag OPTIONAL KITSNote: Please indicate any kits to be included in the quote.Small Volume Prover Kit Options: Spare Parts Kit Leak Detector Kit Drain Kit Shaft Seal Monitor Kit Insulation Kit Spectacle Blind Kit Thermal Relief Kit Density Kit PDAQ Kit (Does not Include PROVEit Software) Special Tagging Please Provide Tag #'s SPECIAL REQUESTS / ADDITIONAL INFORMATIONAny special requests or any questions, please call FMD or your local representative for assistance.Date* MM slash DD slash YYYY EmailThis field is for validation purposes and should be left unchanged. 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