14th-Edition-BriskHeat-Product-Catalog A | Seite 141

APPLICATION QUESTIONNAIRE

Your Heating Specialist since 1949

General Heating Application Questionnaire: Part II
PART D: POWER REQUIREMENTS
Voltage:

120VAC

208VAC

Phase:

Single

3 Phase (Wye)

Frequency:

60Hz.

Grounded?:

Yes

Plug Preference:

240VAC

50Hz.

277VAC

3 Phase (Delta)
DC

480VAC

Other

600VAC

Other

Other

No
Please Recommend

Bare Wire

Plug:

PART E: HEATER CONSTRUCTION REQUIREMENTS
Do you have certain product specifications that must be satisfied with
this heater / system?

Yes

No, please recommend

Product type (heating tape, heating cable, heating jacket, etc):
Exterior material (silicone rubber, PTFE, BriskClean cloth, etc):
Closure / attachment method (adhesive, hook and loop fastener, hook and lace, etc):
Other specifications:

PART F: TEMPERATURE CONTROL REQUIREMENTS
Would you like BriskHeat® to recommend your temperature control solution?:

Yes

No

If no, please describe the temperature control that will be used: (type of sensor, model, etc)

Distance from temperature controller to heater:
Do you intend to connect the temperature controller to a computer?:

Yes

No

Do Not Know

PART G: ADDITIONAL COMMENTS

Toll Free: 800-848-7673

Phone: [phone]

w w w .BriskHeat. c o m

Email: [e-mail] Fax: [phone]

© BriskHeat Corporation. All Rights Reserved. 16-03

APPENDIX

Thank you for filling out this questionnaire. Please submit it to the factory or your local representative for a
recommendation.

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