Name *

First

Last

Email *

Phone Number *

Company Name *

Plant Location *

Industry or Application *

Type of fluid to be pumped *

Shear Damaging - Describe *

Describe Solids Content *

Is this pump considered sanitary?YesNo

Sheer thinning?YesNo

Sheer thickening?YesNo

Capacity (GPM or M/3h please specity)

TDH (Feet or Meters please specify)

Suction Pressure (Feet or Meters please specify)

NPSHa (Feet or Meters please specify)

Temperature (Fahrenheit or Celsius)

Max Solids (Inches or Millimetres please specify)

Viscosity (cP)

Air/Gas Entrainment %

Solids %

pH

Driver Voltage

Specific Gravity

Will this replace an existing pump? (if YES proceed below) *

• Yes
• No

Pump Type

Current Pump Case Material

Problem with Existing Pump

Suction & Discharge Pipe Sizes

Is the pump Close-coupled, Direct-coupled, Sanitary, V-belt or other?

Is Discflo providing the motor?YesNo

Complete PumpYesNo

Pump with seal/packaging only?YesNo

Bare Pump?YesNo

Comment

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