Customer Application Design Specifications

Please fill in this form as completely as possible to ensure we can address all your specific needs.

Hazardous Location : Yes No
Corrosive Environment : Yes No
Electric Driven
Gasoline Driven
Air Driven
Special Mounting Base
Automatic Start/Stop Control Yes No
Electronically Heated
Natural Gas
Voltage :
Phase :
Hertz :
Amperage :
Hour Meter(s) : Yes No
Type of Fluid Being Pumped : Water Other (specify) :
Municipal Water Feed
Well Feed
Tank Feed
Closed Loop System
*Specify Amount of Suspended Solids

Temperature :

Other Conditions:

High Inlet Water Temperature Protection Yes No
Low Inlet Water Pressure Protection Yes No
Upstream (High Pressure)
Downstream (Low Pressure)
Remote Chemical Station
Other (specify)
WHMIS/Chemical Data Sheet Available : Yes No
Single Gun
Other (specify)
Length of Discharge Piping:
Number of Active Guns :
Pulsation Damper : Yes
Gauge : Yes
Standard Hose/Gun/Wand with Unit : Yes No
Extra : Hose Gun Wand Nozzle (specify)

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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