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Application Form for Pad Mount Transformers

Your Information (RED fields are required):
Your Name (first and last): 
Your Title: 
Company Name: 
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: 



Primary Design:     If live front 
If dead front 


Secondary bushings: 

Cooling fluid:     Winding material: 



Gauges and accessories: (check any that are applicable)
Oil level gauge         w/ contacts
Dial type thermometer       w/ contacts
Pressure vacuum gauge    
Pressure relief device
Pressure relief valve
Pressure bleeder valve
Sudden pressure relay w/ seal in
Drain & sample valve
Fans
Winding temperature gauge w/ contacts


Fusing: 

Switching: 

Additional comments or specifications:

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