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 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: Date Format: MM slash DD slash YYYY Phone This field is for validation purposes and should be left unchanged.
