Your Name (Please provide first and last name) REQUIRED:

Your Company REQUIRED:

Your Email REQUIRED:

Your Contact Phone Number REQUIRED:

Your Fax Phone Number:

Serial number (if a replacement pump):

Media to be pumped:

Operating temperature (F):

Specific gravity:

Viscosity (cps):

Particulate Size:

Performance Requirements for GPM:

Performance Requirements for TDH or PSI:

NPSH available:

Max working pressure requirement:

Suction Line Size:

Suction Line- Total Elbows:

Suction Line - Total Tees:

Suction Line - Total Valves:

Discharge Orientation (45dg / 90dg):

Casing Drain Orientation:
Side LeftSide RightCenterFront

Discharge Line Size:

Discharge - Total Elbows:

Discharge - Total Tees:

Discharge - Total Valves:

Discharge - Any other equipment that should be considered for pressure drop:

Material:
Ni-Al-BzStainless SteelDuplex 2205Other

If other material:

Pump Assembly:
Close-CoupledFrame mounted

Impeller Diameter:

Electrical Specification - Voltage:

Electrical Specification - Phase:

Electrical Specification - Hz:

Motor Enclosure:

Ambient Temperature:

Special motor requirements:

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