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Company Information

Company name*

Telephone*

Fax*

Contact*

Position*

Address*

City*

State*

Zip code*

Email*

Classification*

UserDistributor/ResaleOEMExport

Liquid Data

Liquid Name

Specific Gravity

Fluid Temperature (°F)

Minimum Temperature (°F)

Concentration %

Viscosity (cP)

Vapor Pressure (PSIA)

Max Temperature (°F)

Solids

Percentage

Type

System Data

Flow rate:

Normal (GPM)

Minimum (GPM)

Maximum (GPM)

Suction Pressure (PSIG)

Discharge Pressure (PSIG)

Total Dynamic Head (Ft)

Differential Pressure (PSIG)

Suction:

Suction LiftFloodedVacuum

NPSHA (Ft)

MAWP - Max Allowable Working Pressure (PSI)

Special Requirements/Materials

Specified Materials:

Impeller/Gear/Vane:

Bearings:

Case/Housing:

Shaft/Sleeve:

Elastomers - Gasket/O-ring:

Seal:

MechanicalComponentPacking

Seal Construction (i.e. seal faces, elastomers, etc.):

Flush Plan:

Flanges or NPT Connection:

150# RF150# FF300# RF300# FFNPT

Flange or NPT Size (Suction/Discharge):

Baseplate:

Carbon SteelStainless SteelCorosion ResistantOtherNone

If other, please specify:

Special Piping, End Connections:

Inspection/Test Requirements

Special Data or Drawings?

Shop Inspection:

Hydrostatic Test:

Performance Test:

Type of Drive (Select All That Apply)

Drive Type:

ElectricHydraulicEngine DrivenAirNone

If Air Driven, Plant Supply Air Available (PSI)

Power:

ACDC

Voltage:

Phase:

SingleThreeN/A

Hertz:

50 Hz60 HzVariable Speed

Area Classification:

Non-Classified (General Purpose)Classified (Hazardous)

If Hazardous, Please Specify Requirements and Classification:

Area:

IndoorOutdoor