Water Re-Use - 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.)

Rain Water
Gray Water

Domestic Use
Irrgation
HVAC
Process

Name

Company Name

Address

City

State / Province

Postal Code

Country

Phone # (including area code) ext.	Fax # (including area code)
Email Address

.............................................................................................................................................

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

TDS ppm pH

Filtration:
- Type

- Micron

Softener: Yes, No

Re-Use Goal:

Current Treatment - if any

Building Operates
- Hours/Day

- Days/Year

Comments / Questions

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