Commercial Load Request

Customer Information
Date:*
Date Format: 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:
Date Format: 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

Customer Information