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Applications Questionaire
Provide contact information for preferred method of response:
Phone
E-mail
Fax
Name:
Title:
Company Name:
Company Address:
City:
State:
Zip Code:
Phone:
Fax:
Email Address:
Company Website Address:
PLEASE PROVIDE ALL APPLICATION INFORMATION BELOW
CHEMICAL INFORMATION
Chemical Name
Does the application allow for chemical dilution?
yes
no
APPLICATION CONDITIONS
Voltage
Requirements
USA
n/a
120V 60Hz
220V 60Hz
Intl
n/a
230V 50Hz
250V 60Hz
PUMP SIZING
System line pressure
psi
System flow rate:
variable
max gpm
Solution strength:
Dosage required:
ppm
If dosage is unknown and application is for oxidation please list contaminants:
Iron
ppm Manganese
ppm Hydrogen Sulfide
ppm
Target residual:
ppm
