Complete the form below and a Thermal Gas representative will contact your shortly regarding your request. Don't feel like typing? Give us a call. We will be happy to help you! (800) 896-2996. We operate on extended business hours on US eastern time schedules. If you have a written specification or drawings, please e-mail to info@thermalgas.com or FAX to (770) 667-3857. Otherwise, please complete the following information and submit. Your information will not be shared with, or sold to, any entity. Contact Information Title First Name Last Name E-mail Business Information Business Name Street City State ZIP Code Telephone Fax Project Information Location / Project Name Project Bid Date Projected Installation Date Project Determination Criteria What refrigerant gases are to be monitored? R-11R-12R-22R-23R-123R-134aR-141bR-507aR-717 Other Gases? Are possible contaminants nearby? (i.e. cleaning fluids, ammonia or other hydrogen or chlorine sources) YesNo Number of chillers? Distance between chillers? Size of room? Number of Sensing Points Number of points of egress (man-doors) from mechanical room? Options Desired Check all that apply. If replacing an existing system, check only new items needed or those to be replaced. Local HornLocal StrobeRemote Display PanelRemote Horn/Strobe ComboEmergency Power Shut-Off SwitchEmergency Ventilation SwitchBattery BackupCalibration KitAnalog Output for BMS ConnectionSCBA & Wall Case Remote Horn/Strobe Combo Quantity: Emergency Power Shut-Off Switch Quantity: Emergency Ventilation Switch Quantity: SCBA & Wall Case Quantity: Other Safety Switch Requirements: Comments Please include any additional information you believe relevant