Rev. 18 / 01.10.06 / 25126American Petroleum Institute Certification Programs

API Monogram Licensing

Licensing Information Form For API Spec 12KIndirect Type Oilfield Heaters

ProductsHeatersShellsCoils

Submitted By

Company:

Facility:

Address:

Return To:American Petroleum InstituteMonogram Program1220 L Street, NWWashington, DC 20005-4070USA

Please place a check mark () in each box that corresponds to the products you are applying to manufacture and monogram. (If using electronic PDF form, click your mouse in the corresponding box and the check mark will appear.)

Rev. 18 / 01.10.06 / 25126American Petroleum Institute Certification Programs

Text4: Text9: Text5: Text6: Text7: Text8: Check Box107: Check Box108: Check Box109: