Rx Monitoring Services
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Order Power Quality Site Survey

Standard Service is for 10 days

If your company is new to working with Rx, please give us a call at
1-888-329-2321 Ext. 201 before ordering online. See ordering instructions for more information.
Please note that any order placed after 3:30PM EST/EDT and on the weekend will not be processed until the following business day.

In order to fulfill your order with accuracy, all applicable fields must be entered.
Fields marked with an asterisk(*) are required.

Order Information
*Your Company:
*Ordered By (Your Name):
*Phone Number:
*Email Address:Please Double-Check your email address
PO/Contract Number:Rx does NOT accept credit cards through this form.
Client/Region:
ASM/DM:
Email Addresses For Report Distribution:
Installer Name:
Installer Phone Number:
Installer Email Address:
*New Install Or Existing System:
Site Address
Site Code or Serial Number:
Site Contact Name:
*Site Phone Number:
*Site Name:
*Site Street Address 1:
Site Street Address 2:
*Site City:
*Site State/Other:
*Site Postal Code:
Site Country:
Ship To Address (Copy from Site Address)
As of 01/10/2012 A Shipping Address is required.
*Shipping ATTENTION:
*Shipping Phone Number:
*Shipping Street Address 1:
Shipping Street Address 2:
*Shipping City:
*Shipping State/Other:
*Shipping Postal Code:
Shipping Country:
Shipment Priority
*Date Monitor Should Arrive At Site:Please select a valid date(mm/dd/yyyy).
The monitor will be shipped to arrive on this day.
*Shipping Method: (Rx primarily uses FEDEX-- methods by default)
Account Number:
Equipment Information
*Name/Model Of Equipment To Be Monitored:
*Plug/Receptacle Type Needed By Equipment:
HELP
If unsure, please describe plug in the 'Notes' section below
Equipment Age:Round to nearest month or year
Equipment Voltage:
Power Conditioner:
Notes
Generally, Rx staff will be able to determine the configuration of equipment needed for the survey. However, if you have any special requirements, such as plugtype, line-impedance(Z-Brick), only monitor temperature&humidity or are having problems at the site, please make note of them here:
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Please note that any order placed after 3:30PM EDT and on the weekend will not be processed until the following business day.