Please provide us with as much information as is readily available to you.
Completion of any field on this form is optional.

REQUEST QUOTE ON THE FOLLOWING:
(Please select at least one of the choices below so we can best determine your needs.)

Scale Removal Filtration    Manual    Self-Cleaning Copper/Silver Ion Generator Ozone Reverse Osmosis Solids Removal

Pump Products: Suction Diffuser Self-Cleaning Suction Screen

Valves: Hydraulic Balancing Eccentric Plug Silent Check Non-Slam Check Triple-Duty

Name

Company Name

Address


City


State / Province


Zip/Postal Code


Country


Phone # (including area code)


Fax # (including area code)


Email Address

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Total system Gallons: gallons

Circulation line size inches

Circulation rate gpm

Circulation Pressure psi

Average Temperature in system °F

Degrees of heat exchange

Make-up water source:
City, Well, Other (specify)
TDS ppm    pH

Filtration:

- Type


- Micron

Softener: Yes, No

Treatment Goal:

Current Treatment

Current Conditions:
Scale
Sediment
Biofouling
Corrosion
 

System Operates

- Hours/Day

- Days/Year

Annual cost of current treatment: $

Comments / Questions

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