L. A. Prillaman Co., Inc.

P O Box 6323

Ashland, VA 23005

804-798-1455   fax:  804-798-2861

joep@laprillaman.com

 Unit Heater & Infra-Red Heater Parts Request

 To:  L A Prillaman Co                                  Job Name:______________________

Fax:  595-2612                                             Location:_______________________

                                     Date: ___________

 Requested by:__________________      Company ______________________

Need Quote by: _________________    Fax: __________________________

                                                                        Phone: ________________________

 1. Existing Unit:   Mfgr: ___________      Model: ________________________

                                                                        Serial Number: __________________

 2.  Power:    HP: __________   Voltage/Phase/Hertz: ____________________

 3.  Gas:    Natural: __________   LP: __________________

 4. Heat Load:            MBH (or BTU/H) ______________  If not available then

                                    Temperature Rise: _____________ complete “Dimension”   

CFM: _______________________     &  “Construction”

5. Replacement part needed:

            Name

            Description

            Voltage

            Attach photo or attach sketch

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