Order Form

Ordering Information for Controlled Temperature Warehouse Monitoring Miller Brewing Distributors

To place an order, please fill out the Order Form below. This information will be used to generate the necessary paper work to complete your order.

The Loggers are custom ordered and programmed.

Please allow approximately 4-6 weeks for shipment. Shipments are made via USPS or Federal Express. All equipment orders must reference a PO. Credit approval may be required.

Complete separate form for each warehouse location. *Denotes Required Fields

ORDER FORM
Service Option*: Please note: if "Option One" is chosen, NO Equipment Purchase is necessary.	Option One: Monthly Monitoring Service.  Recommended Solution 3 Year Contract Required Security Deposit Required: (1 logger, 2 or 4 sensors) = $250 (2 loggers, 6 sensors) = $500
	Option Two: Equipment Purchase Only
	Report Services (Optional Service) Receive access to monthly CTW report to view and download. Subscription is $15/month, based on a one year contract.
Number of Sensors Option 2 4 6 8 Monthly Monitoring Service $65 $65 $130 $130 Equipment Purchase** (Dry Sensors) $675 $725 $1,325 $1,375 Equipment Purchase** (Water Proof Sensors) $755 $885 $1,565 $1,695 ** Applicable sales tax and shipping charge will be applied. Please note:  if "Option One" is chosen, NO Equipment Purchase is necessary.
CUSTOMER INFORMATION
Date:	P.O.# (NOTE:  A P.O. NUMBER IS REQUIRED FOR ALL "OPTION TWO" EQUIPMENT PURCHASES!)
Your Name*:
Business Name*:
Distributor Number*:
Address*:
City*:
State*:
Zip Code*:
Telephone*:	Ext:
Fax:
Email Address*:
Miller Brewing Sales Manager:
Billing Method*: (For Monthly Monitoring Service Only - Equipment Purchases billed upon shipment)	Choose Billing Method Quarterly Payment Annual Payment
WAREHOUSE DESCRIPTION
Warehouse Address:
City:
State:
Zip Code:
Warehouse Telephone Number:	Ext:
Facility Square Footage:
Required No. of Dry Sensors:
Required No. of Water Proof Sensors:
Ceiling Height Warehouse:
Product Stacked Height:
Zone No. 1 Description:
Zone No. 2 Description:
Zone No. 3 Description:
Zone No. 4 Description:
Zone No. 5 Description:
Zone No. 6 Description:
(This information will be programmed into loggers to identify sensor location by zone.  Please be as accurate and descriptive as possible.   Include the following in Zone Description: specific location (by docks doors etc.)  and direction (SE corner)
Note: The three questions below must be answered for order to be placed.  Monitoring Service Customers must answer "Yes" to these questions.  Equipment Purchaser should simply answer "No" to these questions.
Non-Dedicated Phone Line Available for Modem:*	Choose Yes No Required Field!
120 VAC Outlet Available for Modem:*	Choose Yes No Required Field!
Location in protected, dry, conditioned warehouse space available for logger and modem:*	Choose Yes No Required Field!
The XR440 Logger is backed by a three (3) year limited warranty.  All other products are backed by a one (1) year limited warranty.  Products that are damaged or modified are not covered.    Balance Engineering's sole obligation for products that prove defective will be replacement, repair, or refund, at our discretion, for products returned within the warranty period.  In no event shall Balance Engineering's liability exceed the buyer's purchase price.  We do not accept returns shipped to us C.O.D.  Special order or damaged items are not returnable.  Shipping and C.O.D. charges are not refundable. Please note:  if "Option One" is chosen, NO Equipment Purchase is necessary.
Optional Sensors and Devices: PT 940 - Water Proof Temperature Sensor with extension cable (150 feet) $65.00 PT 916 - Water Proof Temperature Sensor with extension cable (150 feet).  (includes CF 916 - 1/8" fitting for PT 916) $75.00 RH & Temperature Probe $235.00 Light Sensor $35.00 Pulse Count Module $120.00
Comments or Special Instructions Regarding this Order:
Optional: Please tell us how you heard about Balance Engineering:
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If you have any questions, please call us at (317) 844-3178, email info@balanceeng.com,
or  Fax (317) 844-6543

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