Please print out this page, fill in the
necessary information, and fax to us at 815/962-5466.
| OD (Outside Diameter of Packing): |
| SH (Stack Height of Packing): |
| CS (Cross Section): |
| R (Radius): |
| ID (Inside Diameter of Packing): |
| Temperature: |
| Pressure: |
| Quantity: |
| Delivery Date: |
| Company Name: |
| Date: |
| Contact: |
| Phone: |
| Fax: |
Impregnation: |
EXCELSIOR, INC.
P. O. BOX 970
ROCKFORD, IL 61105
Phone 815/987-2900
Fax 815/962-5466
Copyright ©
2006 Excelsior, Inc. All rights reserved.
Revised:
06/02/06