| To
request more information, please complete the form
below. |
| Bold fields are
required |
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Contact
Information |
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Name |
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Company |
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Address
1: |
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Address 2: |
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City: |
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Postal Zip
Code |
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State |
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Country |
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Phone
No: |
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Email: |
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Type of Use: |
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Residential |
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Commercial |
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Public Water System |
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Describe where
the chlorine will be used
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Describe your existing chlorination
practices
(if any) |
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Amount of Chlorine Used/Needed (if
known): |
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Describe the size/capacity of
the well, treatment plant, pool, or any other information
describing size of water system: |
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Do you have a vacuum injection
system? |
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Yes |
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No |
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Do you need on/off control with the
system? |
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Yes |
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No |
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Do you desire automated or manual
caustic density control? |
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Automatic |
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Manual |
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Do you desire automatic or manual
dosage control? |
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Automatic |
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Manual |
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Will the system be installed
outdoors? |
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Yes |
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No |
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If indoors, is the room well
ventilated such as in a chlorine room? |
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Yes |
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No |
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List any other needs, concerns,
and/or regulatory requirement information |
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