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Water Treatment - Request Quote

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.)

Water Treatment: Scale Removal Filtration Manual Self-Cleaning Iron Removal Ozone Reverse Osmosis Solids Removal UV Light Ultrafiltration	Chemical Formulations: Boiler Water Cooling Water RO - DI - Potable Process Water Raw & Waste Water
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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All information is kept strictly confidential by Progressive Environmental Co.

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