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In order for IST to recommend suitable instruments for your application,please complete and return this form. Fields with red asterisks (*) are required.

 Name
 *
 Title
 *
 Company
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 Address
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City 
 *....State ....Zip
 Country
 *
 Telephone
 *.....Fax
 E-mail
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GENERAL INFORMATION:
  Application:
 
 
  1. Gases to be monitored and desired ranges (PPM, %LEL, or % by volume)
  

  2. Interfering gases and possible concentration ranges (PPM, %LEL, or % by volume), if any:
  

  3. Operation temperature range: (optional) at sensor; at instrument.

  4. Humidity range: (optional)  at sensor; at instrument.

  5. Is there an existing gas monitor in use? NO      YES      

      If yes, please indicate manufacturer, model, and any current problems:
     

  6. Type of instrument required:
       Portable          Desktop        Rackmount
      
 Weatherproof or wallmount      Explosion-proof

  7. Number of sensor points required:

  8. Maximum distance from sensor to control room:

  9. Line Power: Volts       Hertz

10. DC Standby Power: (optional) 

11. Additional information and requirements: