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Please complete as much of the information below as possible and return.


  Personal Information
First Name: *   
Last Name: *   
Company: *   
Street Address 1:   
Street Address 2:   
City:   
State: *  
Zip:   
Phone: *   
Fax:   
E-mail: *   


  Technical Information
Application Description (What are we protecting):
Water Source/Supply (i.e. lake, river, municipal):
Min. Water Temperature:
Max. Water Temperature:
Contaminants/Debris in water:
Min. Flow Rate:
Max. Flow Rate:
Min. Pressure:
Max. Pressure:
Filtration degree required:
Line Size:

OPTIONS: (Please check one box in each category)
Type of Drive:   Hydraulic   Electric
Power Source:   120V, 1 Phase   220V, 1 Phase   220/440V, 3 Phase   Other
Additional Requirements (i.e., UL, NEMA 4X enclosure, etc.):


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