Owner manual
13
Schedule 1: Customer Information Form
Customer Billing & Notice Information for Monthly Web Service
Customer Name: Contact:
Street: City: State: Zip: Phone:
Service Agreement Number: Effective Date:
Fees
Monthly Fee: $ 1x Activation Fee: $
Tank Site Information
Site Name: Contact (if any):
Street: City: State: Zip: Phone:
Transmission Coverage Checked: Y or N Transmission Frequency: Every 12/24/ hrs.
Tank Information
Tank Identification at Tank Site (Serial Number if possible):
Nominal Size & Model: Product:
Full Reading: (inches of H20)
Reorder Reading: (inches of H20)
Low Level Alarm Reading: (inches of H20)
Please Circle One:
Tank Orientation: Vertical or Horizontal Unit installed on: Tank or Instrument Stand
Are Extra Alarms to Customer Required: Y or N Original D.P. Gauge: Removed or Retained
Contact for Web Site User name and Passwork
Customer Name: Contact:
Street: City: State: Zip: Phone:
Current DataQwest Web Site Username (if any):
Alarm Method: Email Address:
Fax Number:
Name of Contact:
(000) 000-0000
ABC Gas Distributor
John Williams
123 West Street
XX 00000 (000) 000-0000
TWRB-123 00/00/00
ACE Metal Works Inc.
Jack Doe
7878 Ginger Road
XX
Someville
Someville
00000
(000) 000-0000
JL Welding Company
Jane Doe
77 Hickory Lane Someville XX 00000
JLWelding@JLWelding.com
(000) 000-0000
Jack Smith
311
100
85
S/N-XXXX
VT-6,000-250
Nitrogen
JLWelding
Appendix B: Example of Schedule 1- Customer Information Form