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EZ Set-up Form - 3DT for Canning & Bottling
Your Name:
*
Your Email:
*
Your Phone Number:
*
Controller Owner (Primary Rep) Name:
*
Region:
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North America
Latin America
APAC
Greater China
Middle East & Africa
Europe
Company Code:
*
1001
2001
Which Commercial Model Are You Using?
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Standard Model (Activation / Subscription)
Capital “lease” model (MUST INCLUDE WQI/EGIC+)
Other (CAF-preapproval needed)
Will you be using the GEN DS-WQI+EGIC bundle?
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Yes
No
Note - Additional fee for WQI/EGIC+ will be applied to ALL controllers for this site.
How many connected (New + Existing) controllers are at the site?
*
District:
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IS101
IS101 NEW CONST
IS102
IS102 NEW CONST
IS103
IS103 NEW CONST
IS104
IS104 NEW CONST
IS105
IS105 NEW CONST
IS106
IS106 NEW CONST
IS107
IS107 NEW CONST
IS108
IS108 NEW CONST
IS121
IS121 NEW CONST
IS122
IS122 NEW CONST
IS124
IS124 NEW CONST
IS125
IS125 NEW CONST
IS126
IS126 NEW CONST
IS127
IS127 NEW CONST
IS128
IS128 NEW CONST
IS129
IS129 NEW CONST
IS131
IS131 - NEW CONST
IS132
IS132 - NEW CONST
IS133
IS133 - NEW CONST
IS134
IS134 - NEW CONST
IS135
IS135 - NEW CONST
IS136
IS136 - NEW CONST
IS137
IS137 NEW CONST
IS143
IS143 NEW CONST
IS144
IS144 NEW CONST
IS145
IS145 NEW CONST
IS146
IS146 NEW CONST
IS147
IS147 NEW CONST
IS148
IS148 NEW CONST
IS149
IS149 NEW CONST
MN101
MN102
MN103
MN104
MN105
MN106
MN107
MN108
WL101
WL102
WL103
WL104
WL105
WL107
WL108
WL121
WL123
WL124
WL125
WL126
WL127
WL128
WL141
WL142
WL143
WL144
WL145
WL146
WL147
WL151
WL152
WL153
WL154
WL155
WL156
WL157
WL161
WL162
WL163
WL171
WL172
WL173
WL174
WL175
WL182
WL183
WL184
WL185
WL186
TS101
TS102
TS103
TS104
RT111
RT112
RT113
RT114
RT120
RT121
RT122
RT131
RT132
RT133
RT141
RT142
RT143
This district selection is associated with New Construction
and your request will be routed to Tina Thompson
District
*
District Manager Name:
*
SBU:
*
Institutional
Food & Beverage
Manufacturing
Transportation
Are You Ordering a New Controller or Using an Existing Controller?
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Ordering a New Controller
Using an Existing Controller
System Application Type:
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Tunnel Pasteurizer
Bottle/Can Warmer
Cooling Tunnel
Combinations
Continuous Rotary
Hydrostatic Sterilizer
Batch Retort
Please Select:
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Bev-Brew
Thermal Processing
Does the System Have a Direct Cooling Tower?:
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Yes
No
Customer Information
Customer Name:
*
Customer Location
(City, State, Zip Only):
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Sold-To Number:
*
Ship-To Number
(only one ship-to entered here):
*
On Site Contact Name:
*
On Site Contact Phone Number:
*
Controller Security Information
Customer Connected? (Analog/Digital/Modbus)
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Yes
No
Analog I/O or Discrete Digital
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Yes
No
Modbus Communication to PLC or DCS
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Yes
No
Segregated from Business LAN
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Yes
No
Operations Network allows remote access
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Yes
No
What type of Modbus is being used?
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RS-232
RS-485
TCP/IP
Next Gen Controller Modbus config.?
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Slave
Master
Unknown
Is this Modbus Master a Nalco provided device?
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Yes
No
Next Gen Modbus IP Config
IP Address
Subnet Mask
Default Gateway
What is the Modbus Peer Address?
Internet Access via Customer Network
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Yes
No
Segregated from Business LAN
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Yes
No
Operations Network allows remote access
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Yes
No
Any specific reason the system is having customer connection?
Any documentation/Network Architecture for the customer connection?
Customer Security
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Approved
Unapproved
Unknown
Please select the approver?
*
Michael Belsan
Miller Lawrence
Shawn Sellers
Unknown
Contract in Place?
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Yes
No
Part Number/Billing Information
Signed Legal Contract ID #:
Part Number
(only one part number entered here):
*
Quantity:
*
System Name:
*
EGIC Create Configuration File?:
*
Yes
No
Controller Serial Number
(if available):
Replacing a Legacy Controller?:
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Yes
No
Legacy Serial Number Being Replaced:
Has the Controller Been Commissioned Onsite?
*
Yes
No