TAI Services: Request for Chiller Bid

Date:

Company Name:

Your Name:

Address:

Address 2:

City:

State:

Zip:

E-mail:

Phone:

Fax:

Job Location:

City:

State:

Zip:

Site Contact:

Site Phone:

Manufacturer:

*Model Number:

Serial Number

Vessel 1:

Vessel Name:

Count:

Length:

Vessel 2:

Vessel Name:

Count:

Length:

Vessel 3:

Vessel Name:

Count:

Length:

Vessel 4:

Vessel Name:

Count:

Length:

Quantity of units with this model number:

Price as:

Same Trip
Separate Trip
Both

Location:

Inside
Outside

Leaking?

Yes
No

Safety:

Safety Class -- if so, how long?

Safety Gear

Please include any additional information (i.e. quote each vessel, request for date last tested, etc.):

Ready to Schedule?

Yes
No

Request for Chiller Bid

Request for Chiller Bid

Contractor

Job Site / Equipment

Tube Information