L. A. Prillaman Co., Inc.

P. O. Box 6323

Ashland, VA 23005

804-798-1455  fax: 804-798-2861

joep@laprillaman.com

COOLING TOWER TAKE-OFF

Requested by:

            Company:

            Phone:

Fax:

Quote needed by:

Job Name or Building Number:

Location or Base:

Street Address:

City                                                                 State:  VA

Replacement:  Y/N             Manufacturer:

            Type:  Open Tower              Closed Circuit Cooler          Condenser

Model Number:                                Serial Number:

Thermal Duty:          GPM,               EWT,              LWT,               wet bulb.

Motor(s):  Quantity:              HP        voltage      phase       hertz

Sump Heater (s) 

UNIT Dimensions:

Location: Free          Indoor             In Well            In fence

Sketch Layout, with dimensions

Answer all questions and return via fax or e-mail.  Include photos if possible.

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