Customer Intake Form
Billing Info
Customer Name
*
First Name
Last Name
Company Name (We use use this to put on all shipments to your facility)
*
Company Billing Email Address
example@example.com
Billing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Shipping Info
Is this the name TruSteel should place on all shipments of equipment/parts?
Yes
No
Name to be placed on Shipments (Large and Small packages)
*
First Name
Last Name
Customer Email (Used for shipment tracking and email correspondence throughout Pre-Installation)
*
example@example.com
Phone Number (This should be the person who TruSteel will contact about the Pre-Installation)
*
-
Area Code
Phone Number
Shipping Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What type of address is this? If you have a FORKLIFT available, please select "without Liftgate Service"
*
Commercial Address without Liftgate Service
Commercial Address with Liftgate Service
Residential Address without Liftgate Service
Residential Address with Liftgate Service
Equipment Info
Check All Equipment Ordered: [Check All That Apply]
*
AutoVap15 Basic Package
AutoVap15 Discharge Package
AutoVap30
AutoVap40
AutoVap100
DR10
BT30 (Balancing Tank)
InstaCool
Other
Link to Proposal (if available)
Link to preview of accepted proposal
We Ordered:
AutoVap15
AutoVap30
None of the Above
Will the AutoVap be placed in a C1D2 compliant room?
*
Yes
No
What Solvent(s) will you be extracting with?
*
Ethanol
Heptane
Methanol
Acetone
Hexane
Acetonitrile
Other
What power does your facility have?
208V/3Ø
240V/3Ø
480V/3Ø
Type of facility
*
Did you order a DR-10?
Yes
No
Does this facility have a Forklift?
Yes
No, we require a liftgate for freight deliveries.
Select Water Heater Type
Electric
Gas
The AutoVap Water Heater can be either Electric or Gas (if your facility has a constant supply of natural/propane gas). Please select which you prefer.
*
Electric
Gas
AutoVap15 Basic Package: Electric Water Heater (based on your available voltage)
*
HX016-3R 16kW 208V/3Ø/44.4A Draw
HX016-3T 16kW 240V/3Ø/38.5A Draw
HX016-3T7 16kW 415V/3Ø/22.3A Draw
Using our own Electric Water Heater
AutoVap15 Basic Package: Gas Heater (no choice)
Hubbell NX200 120V/1-Phase/12A Draw
Using our own Gas Water Heater
The AutoVap Water Heater can be either Electric or Gas (if your facility has a constant supply of natural/propane gas). Please select which you prefer.
*
Electric
Gas
Select the AutoVap Electric Water Heater (based on your available voltage)
*
HX036-6R 208V/3Ø/99.9A Draw
HX033-6T 240V/3Ø/86.6A Draw
HX036-6T4 480V/3Ø/43.3A Draw
HX033-6S 240/1Ø/137.5A Draw
Using our own Electric Water Heater
Gas Heater (no choice)
Hubbell NX300 120V/1-Phase/12A Draw
Using our own Gas Water Heater
The AutoVap100 Water Heater can be either Electric or Gas (if your facility has a constant supply of natural/propane gas). Please select which you prefer.
*
Electric
Gas
AutoVap100 Package: Electric Water Heater (based on your available voltage)
*
240V/3Ø/290A Draw
480V/3Ø/146 Draw
Using our own Electric Water Heater
AutoVap100 Package: Gas Heater (no choice)
*
Hubbell NX500 120V/1-Phase/12A Draw
Using our own Gas Water Heater
AutoVap Chiller (please choose your required/preferred voltage)
*
TaeEvoTECH121 240V/3Ø/65A
TaeEvoTECH121 480V/3Ø/43A
Using our own Chiller
AutoVap15 Basic Package: For the Chiller, please choose your required/preferred voltage.
*
240V/3-Phase/26.5A (MODEL: TaeEvoTECH051-240)
480V/3-Phase/13A (MODEL: TaeEvoTech051-480)
Using our own Chiller
AutoVap100 Package: For the Chiller (no choice in voltage).
*
480V/3-Phase/121A (30 Tons of Cooling Power)
Using our own Chiller
Does this facility have the space for a large Chiller to be placed outside of the building (either on a concrete slab or on the roof)?
Yes
No, we will install a ventilation system for the HVAC chiller
Vacuum Pump (No Choice)
Welch 2052, 115V 60HZ 1.5 TORR 64 LPM
Variable Frequency Drive For AV15 Feed Pump (No Choice)
*
VFD 208-240V 1HP/1-3Ph/NEMA1/4.2A/0-500Hz
VFD 400-480V 1HP/3Ph/NEMA1/4.2A/0-500Hz
Variable Frequency Drive For AV15 Discharge Pump (No Choice)
*
VFD 208-240V 1HP/1-3Ph/NEMA1/4.2A/0-500Hz
VFD 400-480V 1HP/3Ph/NEMA1/4.2A/0-500Hz
For the DR10 Oil Heater, please select whether you prefer 240V or 480V
*
208V/3-Phase/31A
240V/3-Phase/26A
480V/3-Phase/23A
For the DR10 Mixer VFD, please select whether you prefer 240V or 480V
*
208/240V
480V
For the Variable Frequency Drive (for Feed Pump), please specify your required/preferred voltage.
200/240V - 1 or 3Ø Input (3Ø Output) (MODEL: ESV751NO2YXC)
Variable Frequency Drive (for Auto Discharge), please specify your required voltage.
200/240V - 1 or 3Ø Input (3Ø Output) (MODEL: ESV751NO2YXC)
The AutoVap15 is 9'6" tall. Is your ceiling higher that 9'6"?
Yes, we have plenty of ceiling height.
No, we may need to modify the ceiling.
Is this facility ready to receive this ancillary equipment?
Yes, please deliver right away
No, please delay deliveries
Target Date of Installation (Please note it can take 3-4 weeks to receive ancillary equipment and another week for you to install)
-
Month
-
Day
Year
Date
Additional Requests
TruSteel Sales Representative
First Name
Last Name
Name of person who completed this form
First Name
Last Name
Confirmation (Note: TruSteel will be ordering the specified equipment upon receiving this form, any errors may result in the wrong equipment sent and may delay the project and add extra costs)
*
I confirm all the information on this form is accurate.
Submit
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For Internal Use Only
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