Hello,
It looks like you have either our S351, with a 15-002 bottom attachment, or S390, with a 15-001 bottom attachment. Take a look at the image below to determine which balance you'll need.
I would also recommend double-checking the length of your metal channel, not including the end fittings, since your stamp code would generally indicate that you would have a 30" long metal channel. You'll also need 2920 spring strength options for your replacement balances to support between 12-16 lbs.
It also looks like you have a broken top sash guide. We may be able to supply a suitable replacement but we would need to see an undamaged version removed from the other side or from an identical window in the house to compare to our inventory. Thank you!