Click here for printable APPLICATION DATA SHEET PDF.
(*
required fields
)
*Name:
*Organization:
Address:
Ste./Apt. #
City:
State:
Zip:
*Phone:
Fax:
*E-Mail:
*Brief Description of Job:
New Applcation:
Yes
No
Exact Replacement:
Yes
No
Similar Replacement:
Yes
No
Solve Particular Problem:
Yes
No
Suction Conditions:
Flooded:
Yes
No How Much
Lift:
Yes
No How Much
Under Pressure / Vacuum:
Yes
No
Discharge Conditions:
GPM:
TDH/Pressure:
Other:
Motor Information:
Type:
Select
Electric
Air
RPM:
Select
1200
1800
3600
Unknown
Other
Volt:
Select
115 V
230 V
460 V
575 V
Phase:
Select
Single
Three
Encl:
Select
TEFC
ODP
Explosion Proof
Other
Liquid Information:
Liquid Name:
SG:
Temp:
Visc:
Vapor Pressure:
Abrasives:
Solid Size & Concentration:
Sealing Requirements:
Mechanical Seal:
Yes
No Type
Seal Flush Req:
Yes
No Type
Packing:
Yes
No Type
Other:
Sealless:
Yes
No
Special Options/
Accessories Needed:
