Custom Coil Request for Quote

Complete as much data as you can in the form below.  Based on your responses, Surefin will supply you with a cost estimate for your heating or cooling coil(s) as well as delivery schedule information.   (Note:  Fields marked by * are required)
This form is for ALL TYPES OF COILS. If you need a quote for a tube bundle, click here.

Your Name : *
Company Name: *
E-Mail: *
TEL: *
FAX:
Address: *
City: *
State/Province: *	--Please Select--Not Applicable AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFlordiaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNova ScotiaNunavutOntarioPEIQuebecSaskatchewan
Zip/Postal Code: *

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Existing Coil Information
Manufacturer:
Model #:
Quantity:
Construction information (please fill in as much information as possible)
Coil Type:	--Please Select--Booster Chilled WaterHot Water CondensorHot Oil GlycolEvaporator/DX Steam/DistributingSteam/Standard Steam/OppositeOther (indicate below)
	Indicate coil type if not listed above:
Tube size:	--Please Select--3/8" 1/2"5/8" 7/8"1" Other (specify)
	Indicate tube size if not listed above:
Tube Material:	--Please Select--Aluminum CopperBrass Cupro/NickelCarbonStainless Steel
Fin Material:	--Please Select--Aluminum CopperBrass Cupro/NickelCarbonStainless Steel
Header Material:	--Please Select--Aluminum CopperGalvanized SteelStainless Steel
Protective Coating:	--Please Select--Epoxy PolyesterPolymeric ThermoguardPolyurethaneIriditePhenolic
Dimensions (based on the diagram provided)
Number of Rows:
Fins Per Inch:
FH = Fin Height:
FL = Fin Length:
CH = Casing Height:
CL = Casing Length:
CD = Casing Depth:

Other requirements or information you'd like us to know: