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Counter Application Data Assistance Form
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For prompt Application Engineering Assistance, please detail your application design, performance and cost requirements in the Application Data Form provided and email it to us or call us at+1.800.390.6405 We will promptly review your specifications and contact you with a recommendation - usually within one business day.

Please note that the more detail you provide, the more efficiently and promptly our Engineering staff will be able to help you install the right Veeder-Root product for the job.

We guarantee to respect your privacy and to never release your personal information to a third party. Please read our Privacy Statement for further information on this policy. We look forward to serving you!

* All starred fields are required.

Technical Information

Counter Product Details
Product Type:
Desired Control Action: Check all that apply:
Totalizing Predetermining Batch  
Panel Size: If 'Other', please specify:
Display:
Max # of digits: (choose from 4-8 basd on maximum count value)
Inputs:
If 'Other', please specify:
Input Voltage: VDC VAC
Voltage Output Level: VDC
# of presets:
Outputs:
If 'Other', please specify:
If Relay, what is the load?  Amps
Output Action: Check all that apply:
 Manual Reset   Latched Reset  Other
 
If 'Other', please specify:
Termination:
If 'Other', please specify:
Environment
Operating Temperature: Normal Operating Temp - 32°F to 140°F (0°C to 60°C)

High Temperature: °F ( °C)

Low Temperature: °F ( °C)
Storage Temperature: Normal Storage Temp - 32°F to 140°F (0°C to 60°C)

High Temperature: °F ( °C)

Low Temperature: °F ( °C)
Storage Environment:
If 'Other', please specify:
Communications: Yes No
If Yes, indicate type (choose all that apply):
RS-232 RS-485 Other:
Accessories / Special Options:
If 'Other', please specify:
Will you require any other environmental control components?:

Additional Comments or Unique Considerations:

Project Details
Project Name:
Qty of Prototypes:
Required By Date:
Price Goal: for production Qty's
Annual Qty:
Production Expected Start:

Contact Information

* First Name: Title:
* Last Name: * Company:
* Street Address: Company Website:
* Email:
* Phone Number:
Fax Number:
* City: * How would you classify your business?
* State/Province:
* Zip Code: How would you
like to be contacted?
Phone Email Fax
* Country:

Would you like to receive special offers and notification of new product releases via email? Yes No

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