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Cold Shot Chillers. Economical. Dependable.

Air Cooled
Water Cooled
Pro-Tec Coatings

Home » Applications & Sizing » Medical Questionnaire

Medical Questionnaire

Please fill out the Medical Questionnaire form below

* Required Field

Contact Information

* Name:
Company:
* Email:
Phone:
City:
Website:

Application Information

Type of Process being Cooled:

Equipment Manufacture and Model Number:

City Water Switch Over Required:	Yes	No
Air Compressor and Refrigerated Air Drier Required:	Yes	No
Coolant Flow Rate:		gpm	gph
System Pressure:		psi	bar
Required Fluid Temperature:		°F	°C
Power Requirements:	Volts		Phase	Hz
Type of Condenser:
Chiller Location:
If Outdoors Please Describe Ambient Conditions:

* Any Special Notes:

Project Information

Project Name:
Reference Number:
Job Location:
Project Manager:
Technical Contact:
Phone Number:

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