This form is designed to give us the best idea of what your needs are. Fill it out as completely as possible. Please refer to our glossary for more information on the terminology.
ALL REQUESTS WILL BE ACKNOWLEDGED THE SAME DAY OR NEXT BUSINESS DAY DURING THE HOURS OF 8:00AM-5:00PM EASTERN STANDARD TIME, MONDAY- FRIDAY
Your Information
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*Name: Enter your name
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*Company: Enter a company
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*Address: Enter address
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*City: Enter city
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*State: Enter state
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*Zip Code: Enter zip code
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*E-mail: Enter an e-mail
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*Phone: Enter phone
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Fax:
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Pump Information
Manufacturer:
Model:
S/N:
Size:
Additional Info:
Materials of Construction:
Number of Pumps Required:
Pump Type:
Suction/Discharge Connections:
Seal Type:
Conditions of Service
Liquid:
Concentration:
Viscosity:
min.
max.
Specific Gravity:
Specific Heat (Btu/LB °F):
pH:
Solids Size:
% Solids/wt
Vapor Pressure:
Pumping Temperature:
Min Temp
Max Temp
Is the Liquid:
Conditions of Service
Flow:
TDH:
Differential Pressure:
NPSHa:
NIPA:
Suction Condition:
Ft Flooded/Lift
Duty Cycle:
More Info
Enclosure:
Volts:
Phase:
Hz:
Type:
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