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Commercial Load Request
Customer Information
Date:
*
MM slash DD slash YYYY
Name of Business:
*
First
Location/ Address:
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Account Name (If different from "Name of Business"):
First
Mailing Address (If different from above address):
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Phone
Email
Load Information
Total Load:
*
Outlet Pressure Needed:
*
Will you have a multiple meter manifold?
*
Yes
No
Please list the manifold number (if building will require multiple manifolds), the addresses or unit numbers, and the B.T.U. of M.B.H. load for each.
*
Example: Manifold 1: (unit or address)- ###,### BTU (unit or address)- ###,### BTU (unit or address)- ###,### BTU Manifold 2: (unit or address)- ###,### BTU (unit or address)- ###,### BTU
Type and Size of Inside Piping:
*
Welded or Threaded?
*
Welded
Threaded
Other
Is temporary heating needed?
*
Yes
No
Appox date needed:
MM slash DD slash YYYY
What pressure is needed?
Company of Requester:
*
I understand the following:
*
*There will be additional paperwork for temporary heat.
*All commercial house pipeing is required to have a clock test completed and verified by us before final setting can be done.
Yes, I understand.
Electronic Signature
*
First
Last
Δ