Company Name: 

Name: 

Phone#:                Fax#:

E-mail:

THE FOLLOWING OUTLINES THE INFORMATION NECESSARY FOR PROPER PUMP RECOMMENDATIONS.

LIQUID:

WHAT IS THE LIQUID?    PH: 

SPECIFIC GRAVITY: 

TEMPERATURE:

MAXIMUM *F     MINIMUM *F   OPERATING TEMP *F

VISCOSITY @ MAX TEMP. *F   MIN. TEMP. *F   OPERATING TEMP.*F

VAPOR PRES. @ MAX TEMP. *F   MIN. TEMP. *F   OPERATING TEMP.*F

LIQUID PURITY: other liquids-solids, size and quantity, abrasives or other contaminants-hazardous

MOTOR CHARACTERISTICS:

HP:     VOLTAGE:

PHASE:     HERTZ:

RPM:     ENCLOSURE:

DUTY:

    CAPACITY REQUIRED:  GPM

    TOTAL HEAR REQUIRED:  FT.

    NPSH AVAILABLE:  FT.

INLET (SUCTION) CONDITIONS:

    STATIC LIQUID LEVEL:  

    ABOVE/BELOW INLET:  FT.

    PRESSURE ON SUPPLY LIQUID:  PSIG

    BAROMETRIC PRESSURE (OR ALTITUDE): 

    PIPING COMPONENTS (SIZES, LENGTHS, NUMBER AND TYPE FITTINGS) etc: 

PUMP BEING REPLACED:

    MANUFACTURER: 

    TYPE:    MODEL: 

    WHY IS IT BEING REPLACED:

OUTLET (DISCHARGE) CONDITIONS:

    STATIC LIQUID LEVEL ABOVE/BELOW INLET:  FT.

    PRESSURE AT POINT OF USE:  PSIG.

    PIPING COMPONENTS (SIZES, LENGTHS, NUMBER AND TYPE) etc.: 

ENVIRONMENTAL CONDITIONS:

    DUST, MOISTURE, FUMES & FIRE HAZARDS, etc: 

    NOTES: