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Customer Application Design Specifications

Customer Name:	Date:
Contact:	Position:
Phone No. :	Fax No.:
Email:

Application:

Pressure (PSI) :	Volume (GPM) :
Replacing Existing System	Specify Make/Model:

Operating environment
Hazardous Location Yes No	Corrosive Environment Yes No

Desired Drive System
Electric Driven	Gasoline Driven
Air Driven

Desired Mounting System
Portable	Stationary
Special Mounting Base

Automatic Start/Stop Control Yes No

Desired Heater Type
Electronically Heated	Natural Gas
Propane	Diesel

Electrical Available
Voltage:	Phase:
Hertz:	Amperage:

Hour Meter(s): Yes No

Type of Fluid Being Pumped: Water	Other (specify)

Type of Inlet Conditions
Municipal Water Feed	Well Feed
Tank Feed	Closed Loop System

*Specify Amount of Suspended Solids	Microns

Inlet Water Temperature
C	F

Other Conditions:

High Inlet Water Temperature Protection	Low Inlet Water Pressure Protection
Yes No	Yes No

Desired Chemical Injection System
Upstream (High Pressure)	Downstream (Low Pressure)
Remote Chemical Station	None
Other

Type of Chemical Being Injected
WHMIS/Chemical Data Sheet Available :	Yes No

Type of Discharge Conditions
Single Gun	Multi-Gun
Other	Specify

Length of Discharge Piping:	FT.
Number of Active Guns:

Pulsation Damper:	Gauge:

Standard Hose/Gun/Wand with Unit:	Yes No
Extra:	Hose Gun Wand
	Nozzle (specify)

Additional Information :

After submitting this form a product specialist will contact you by phone unless another
form of contact is preferred. Please indicate this in the Additional Information section.

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