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 AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe 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 Choose OneCoriolisPositive DisplacementTurbineUltrasonicHelical Meter Size Line Size Model Number Process Fluid Flow Rate Min Nom Max Units Choose OneGAL/MINBPHM3HLPH Density Min Max Units Choose OneSGUAPIKG/M3LB/FT3 Operating Pressure Min Max Design Units Choose OnePSIBarkPaMPa Viscosity Min Max Units Choose OnecPcSTSSUmPas Temperature Min Max Design Units Choose OneDegress FDegress C Installation Location Ambient Temperature (Install Location) Min Max Installation Destination (City, State, Country) Installation Climate Choose OneOnshoreOffshoreTropicalArcticLaboratory Prover Type Choose OneStationaryPortable Truck/ Trailer MountThird Choice Agency Approval Choose OneUS/CSAATEXIECEx Hazardous Area Classification PROVER DESIGN INFORMATION: Note: Please indicate any design preferences, otherwise FMD-standard will be used. Wetted materials 304 SS 316 SS Inlet/Outlet Flange Configuration See Table One RR LL RL LR TT 4A Other Other ANSI Flange Rating 150# 300# 600# 900# 1500# *For FMD Models 007-090 Duplex SS flanges are standard and meet the carbon steel pressure rating ANSI/ASME codes. For FMD models 130-200 304 SS flanges are standard, 316 and Duplex SS are optional For FMD 130 or 200 please check here if you required Duplex flanges (Price adder may apply) Flange Type (RF) Raised Face (RTJ) Ring Type Joint Motor Power Supply VAC Hz Phase VDC Hydraulic VAC Hz Phase Tube Finish Wrap Natural Finish Water Draw Calibration Units Choose OneImperial (US)SI (Metric) Standard Calibration Conditions Choose One60 F - 0 psig15 C - 0 Kpag20 C - 0 Kpag 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 Tagging PDAQ Kit with PROVEit Software (includs ToughBook Laptop) PDAQ Kit without PROVEit Software Tag Numbers SPECIAL REQUESTS / ADDITIONAL INFORMATION Any special requests or any questions, please call FMD or your local representative for assistance. Completed by: Date: Date Format: MM slash DD slash YYYY Name This field is for validation purposes and should be left unchanged.
