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Company:
First Name:
Location:
Referal:
Phone:
Email:
Application:
Voltage:
System Type:
Condenser Type
Refrigerant
Operating Range
Control System
Notes
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Chiller Quote Form
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Company
First Name
Last Name
Location
How Did You Hear About Us?
Email - Newsletter
Print Ad - Wines and Vines
Print Ad - Practical Winery and Vineyard
Print Ad - Wine Business Monthly
Print Ad - New Brewer
Print Ad - American Brewer
Print Ad - American Distilling Institute
Trade Show
Internet - Google
Internet - ProBrewer.com
Word of mouth
Phone
-
(###)
-
###
####
Email
Application
Brewery
Winery
Pasteurizer
Machine Cooling
Food Processing
Air Conditioning
Other
Voltage
220V/1PH/60HZ
208V/3PH/60HZ
230V/3PH/60HZ
380V/3PH/50HZ
460V/3PH/60HZ
575V/3PH/60HZ
Not Sure
System Type
Package System (With Tanks & Pumps)
Cabinet Systems (Less Condensing Unit)
Classic System (Less Tank & Process Pump)
Not Sure
Condenser Type
Packaged Air-Cooled
Remote Air-Cooled
Packaged Water-Cooled
Not Sure
Refrigerant
R134A
R404A
Not Sure
Operating Range
15-25F Glycol Temperature
25-35F Glycol Temperature
35-50F Glycol Temperature
Not Sure
Control System
Microprocessor Based
Mechanical Based
Not Sure
Notes
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