EZ Set-up Form - 3DT for Canning & Bottling

Your Name: *

Your Email: *

Your Phone Number: *

Controller Owner (Primary Rep) Name: *

Region: *

Company Code: *

District: *

This district selection is associated with New Construction
and your request will be routed to Tina Thompson

District Manager Name: *

SBU: *

Are You Ordering a New Controller or Using an Existing Controller? *

Ordering a New Controller

Using an Existing Controller

System Application Type: *

Please Select: *

Bev-Brew

Thermal Processing

Does the System Have a Direct Cooling Tower?: *

Yes

No

Customer Information

Customer Name: *

Customer Location (City, State, Zip Only): *

Sold-To Number: *

Ship-To Number (only one ship-to entered here): *

Controller Security Information

Customer Connected? (Analog/Digital/Modbus) *

Analog I/O or Discrete Digital *

Modbus Communication to PLC or DCS *

Segregated from Business LAN *

Operations Network allows remote access *

What type of Modbus is being used? *

Next Gen Controller Modbus config.? *

Is this Modbus Master a Nalco provided device? *

Next Gen Modbus IP Config

IP Address

Subnet Mask

Default Gateway

What is the Modbus Peer Address?

Internet Access via Customer Network *

Segregated from Business LAN *

Operations Network allows remote access *

Any specific reason the system is having customer connection?

Any documentation/Network Architecture for the customer connection?

Customer Security *

Please select the approver? *

Contract in Place? *

Part Number/Billing Information

Who Will Own The Controller System?: (Customer Purchased OR Leased) *

Customer Purchased

Nalco Water Leased - Must be approved by CAF.

Signed Legal Contract ID #:

Part Number (only one part number entered here): *

Quantity: *

System Name: *

SAC Create Configuration File?: *

Yes

No

Controller Serial Number (if available):

Replacing a Legacy Controller?: *

Yes

No

Legacy Serial Number Being Replaced:

Has the Controller Been Commissioned Onsite? *

Yes

No

Billing Arrangement Information

New BA Needed: Select if you are creating a new BA or are changing the overall value of your current BA by more than 10%

Use Existing BA: Select if you are changing the overall value of this BA by less than 10%

No BA Needed - Part of Technology Fund: Select if this is part of a technology fund and prior approval has been obtained by Corporate Account Finance

Billing Arrangement (BA) Type: * 🛈

Existing BA Number: *

Additional Revenue: *