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To request a quote, please complete the
form below. Provide as much information as possible to
receive an accurate quote.
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Contact Information
(Bold fields are required)
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Contact
Name: |
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Title: |
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Company Name: |
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Address: |
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Address (cont): |
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City: |
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State /
Province: |
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Country: |
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Zip / Postal
Code: |
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Phone: |
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Fax: |
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Email: |
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Application |
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New Construction |
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New Use |
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Experimental |
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Replacement Equipment |
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Exist. Equip.
Type |
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Equip. Manufacturer
Model #
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Chlorine
Dose
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Chlorine
Strength |
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Other
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Process Information
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PURPOSE
or
USE:
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Residential Well |
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Commercial Well |
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Small Public Well (<15
Services) |
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Community Well |
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Commercial Wastewater
System |
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Hotel or Resort Wastewater
System |
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Community Wastewater
System |
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Sewer Collection or
Manhole |
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Treatment Process
Add-On |
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Brewery CIP Process |
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Dairy CIP Process |
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Grade A Dairy Water
Supply |
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Poultry Water Supply |
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Aquaculture |
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Agricultural Process
Add-On |
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Drip Irrigation
System |
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Agricultural Irrigation
System |
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Commercial Irrigation
System |
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Commercial Process Wash
Down |
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Coal Bed Methane Well |
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Closed Loop Cooling
Tower |
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Open Loop Cooling
Tower |
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Whirlpool, Spa or Hot
Tub |
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Above Ground Pool |
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Lap Pool |
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Residential Pool |
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Commercial Pool |
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Spray Park |
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Decorative Pond |
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Laboratory Use |
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Other |
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WELLS AND PUMPING STATIONS SYSTEM
CAPACITY (Complete as Necessary to
Describe Chlorine Needs) |
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Well Size |
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Pump Rate |
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Chlorine Demand |
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Desired Chlorine Residual |
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Other Information |
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PONDS AND POOLS
SIZE (Complete as Necessary to Describe
Chlorine Needs) |
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Pool/Pond Size |
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Filter Pump Rate |
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Filter Run Time |
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Other Information |
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WASTEWATER
DISCHARGE (Complete as Necessary to
Describe Chlorine Needs) |
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Flow Range |
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Desired Chlorine Residual |
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Other Information |
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Process
Choices and Options |
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Do you have an existing vacuum injection
system and plan to use your existing
system? |
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Yes |
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No |
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If a vacuum injection system is
needed, will there be backpressure on the vacuum injection
system? |
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Choose either Manual or Automatic
Caustic Density Maintenance System: |
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Manual |
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Automatic |
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Do you plan to install the system
yourself, or hire a contractor? |
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Yes |
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No |
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Other Necessary
Information |
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Submit
Data
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