Full Name
Email
Company
Phone
Zip Code
State
Are you working with a local USA Coil & Air Rep? —Please choose an option—YesNo
Rep Company Name
Rep Contact Name
How did you hear about us? —Please choose an option—Google SearchYahoo SearchBing SearchReferred by USA Coil RepUSA Coil NewsletterTrade MagazineLinkedInYou are a USA Coil & Air RepOther
In what industry do you work? —Please choose an option—ContractorDistributor/WholesalerEnd User – HealthcareEnd User – EducationEnd User – GovernmentEnd User – Real EstateEnd User – HospitalityEnd User – IndustrialEnd User - OtherEngineeringOEMUSA Coil & Air RepOther Rep
Project Name
Coil Tag
Quantity
Casing Material —Please choose an option—Galvanized Steel (std)Stainless Steel
Number of Rows —Please choose an option—12345678
Tube Diameter —Please choose an option—3/8”1/2”5/8”
Tube Wall Thickness —Please choose an option—.014.016.020.022.025.035.049
Tube Material —Please choose an option—Copper (std)Stainless SteelCupro NickelCarbon Steel
Fin Material —Please choose an option—Aluminum (std)CopperStainless Steel
Coil Coating —Please choose an option—YesNo
Fins Per Inch
Fin Thickness —Please choose an option—.005.006.0075.010
Fin Height
Fin Length
OEM Unit Model #
OEM Coil Model #
OEM Manufacturer
Notes
Coil Photo 1
Coil Photo 3
Coil Photo 2
Coil Photo 4
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