GCI Request For Quote

Contact Name:		Phone:
Company Name:		Fax:
Email:
Address:
City:	State: Postal Code:
Application:
Unit Type:
Split System:		Same Skid:
Heat Load (Temp Range):
Coolant (Type):
Outdoor Temperature:	° F ° C
Input Temperature:
Flow Rate:
Pressure:
Voltage, Phase & Hz:
Ambient Temperature's or Location in US:
Remote Start/Stop:
Casters:
Freezestat:
Low Flow Alarm:
Back Flow Prevention:
Other Options Desired:
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1-800-832-3377 • 225-929-9062 • Fax: 225-612-7405 • sales@chillersdirect.com