Taylor-Wharton KeepFull Telemetry System User Manual
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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
(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