C.D.C. - Inquiry Form

To assist you in selecting the proper rupture disc for your application, it is important to begin by providing specific data about your system. You may also download this form for later use.
Fields with * are required.

Name*:

Title:

Company*:

Address*:

City*: State: Postal Code/Zip*:

Country:

Phone*: Fax: E-mail*:

Preferred Method of Contact: Phone Fax E-mail

Maximum allowable working pressure (MAWP) of the vessel:

Minimum rupture disc nominal diameter to meet relieving requirements:

Maximum normal operating conditions:
Pressure:
Temperature:

Rupture disc burst conditions:
Pressure:
Temperature:

Backpressure / vacuum conditions: (See Notes Below.)

Process media state:

Service Conditions:

Code / Standards requirements: If "Other":

Appropriate rupture disc material to meet corrosive and/or temperature requirements:
If "Other":

Appropriate rupture disc holder material to meet corrosive and/or temperature requirements:
If "Other":

Flange connection type and class at rupture disc installation: (See Notes Below.)

Other special conditions:

Will this rupture disc be isolating a safety relief valve? (If yes, non-fragmenting design required)

Will the system require a Burst Disc Indicator (B.D.I.®) Alarm System?

(Reorders Only): Manufacturing Number:

Customer's tag number:

If this is a quote request, please indicate quantity:

Further comments:

Please click "Submit" only once!

Additional notes on specific form elements:	Backpressure / vacuum conditions: Some rupture disc models cannot withstand backpressure or vacuum without an additional support component. Please specify whether the rupture disc will experience partial or full vacuum or the amount of backpressure expected during normal service.
	Flange connection type and class at rupture disc installation: Flange connections may include standard raised face, threaded, sanitary, etc. Classes may include ANSI 150# or other, DIN 10 or other, JIS 10 or other, etc. This is important to properly specify the proper rupture disc holder to fit into your system.

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