*Required fields  
   
Contact Name:*
Phone Number:*
Fax Number:
Company Name:*
Address 1:
Address 2:
City:
State:
Zip:
Email:*


 
Minimum Service Line Design Pressure (PSI)*
Maximum Connected Customer Service Line Load (SCFH)*
Service Line Size* Specify Other:
Maximum Service Length*
SDR or Wall* Specify Other:
Meter Size* Specify Other:
Other Important Information

Method of Joining Tee to Main
Tee Base Size
Cutter Size
Tee Outlet Size
Method Specify Other:
Manufacturer Specify Other:

Method of Installing EFV   
Method * Specify Other:
Manufacturer Specify Other:

Type of Service Line Piping*
(Please Select Plastic or Steel)
Plastic

 Specify Other:
SDR or Wall
 Specify Other:
Pipe Manufacturer
Specify Other:
Steel Specify Other:

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UMAC Incorporated
17 Lee Blvd. Ste. D  •  Malvern, PA 19355-1234  •  1-800-524-0566  •  610-407-7200  •  Fax: 610-407-7211  •   Email: umac@umac.com

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