ISO 9001:2000 Registered
Birk Manufacturing, Inc. is dedicated to continual improvement of quality and service, and assures our heaters and thermal systems consistently meet the requirements, expectations and industrial standards of our customers.

Request for Quote Submittal Form

*Please be sure to complete all information marked with * so we may provide a timely and complete quotation.  Birk will have an application engineer call you to help with your thermal systems requirements. 
 

Company Name*

Contact Person*

Address

City

State

Select One Not US or Canada Alabama Alaska Alberta, Canada American Samoa Arizona Arkansas British Columbia, Canada California Colorado Connecticut Delaware Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba, Canada Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick, Canada New Hampshire New Jersey New Mexico New York Newfoundland, Canada North Carolina North Dakota Northern Mariana Islands Northwest Territories, Canada Nova Scotia, Canada Ohio Oklahoma Ontario, Canada Oregon Palau Pennsylvania Prince Edward Island, Canada Puerto Rico Quebec, Canada Rhode Island Saskatchewan, Canada South Carolina South Dakota Tennessee Texas Unknown Utah Vermont Virgin Islands Virginia Washington Washington, DC West Virginia Wisconsin Wyoming Yukon, Canada

Zip

Telephone*

Fax

Email*

How did you hear about Birk?

InternetT/ROther

Heater Information

Birk Manufacturing Preliminary Heater Design

ABCD

Lead Locations

ABCDEF

Type of Heater*

Silicone RubberKaptonButylOther

Size:*

Qty:*

Watts*

Volts*

Lead Length*

Lead Type*

TeflonSROther

Application Info

Pressure Sensitive Adhesive

Operating Temp*

Temperature Controlled*

Control Type

ThermostatT/CRTDThermistor

Ambient Conditions

Target Price

When will delivery be required?

Special Features

Please have an application engineer call

YesNo