E-Survey Form - ElectroCell Systems

"*" indicates required fields

Date*

Zone*

EC Representative*

First Last

CUSTOMER INFO

Customer*

Name

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Primary Phone*

Secondary Phone

Email*

CHILLER / TOWER DATA

# of Centrifugal Chillers*

Total Tons

# of Absorption Chillers*

Total Tons

# Months used Annually*

Please enter a number from 0 to 12.

Weekly Run-time (hrs)*

Please enter a number from 0 to 168.

Max Tonnage Needed*

Avg. Tons

Condenser PSI

Evap. PSI

Any future expansion planned?

# of Units

# of Tons

# of Cooling tower cells

# of Tons

# of Plates

Side-stream filter used??

Type

Chemical Company

Satisfied?

Problems?

*USE AND COST INFO

*It is essential to provide accurate figures for both use & cost for EC to accurately estimate savings

Annual make-up gallons*

Is use metered?*

Electric - cost per kwh*

Water - cost per 1000 gallons*

MISCELANEOUS

Total Sq Ft

Facility Type

(Office, Data Center, Manufacturing, Process, Hospital. Hotel, Casino, etc).

# of Floors

Remarks:

ElectroCell Systems • 3320 Nazareth Road, Easton, PA 18045 • Ph: 1-800-949-3445

BOILER DATA

Boiler Type

Steam

PSI

# of Boilers

Total HP

Gas

Oil

# Months used