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Application Form for Dry Type Transformers

Your Information (RED fields are required):
Your Name (first and last):
Your Title:
Company Name:
Street/Road Address:
City:State/Province:
Zip/Postal CodeCountry:
Phone:  Fax:
E-Mail:

Qty:      Reconditioned   Rebuilt:   New: 
KVA  Phase:  Hz: 
Degree C Rise :  Class:   Impedance: 

Primary Voltage:  Delta or  Wye 
Taps: 

Secondary Voltage:  Delta or  Wye 

Primary Bil:   Secondary Bil: 

Winding material: 

Primary connection: 
Secondary connection: 

Enclosure: 

Fans:    Winding temperature indicator w/ contacts: 

Additional comments or specifications:

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