New Pump Application

Name

First Last

Application Name

Business Name

Email

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Fax

Quantity

Equipment

Brand

Model

Size

Impeller Diameter

Motor HP

RPM

Frame

Other

Pump Metallurgy (Wet End)

Seal Configuration

Shaft Orientation

Horizontal
Vertical

History/Problems or issues with pump

Image

Supply Motor Description

Supply Baseplate Description

Liquid Pumped

Solids

Yes
No

Solid Size

Concentration WGT%

Temperature (F)

Specific Gravity

Viscosity

Vapor Pressure

Suction Pressure

Discharge Pressure

Flow GPM

Head (Ft)

NPSHA (Ft)

Electrical

TEFC
XPL

Volts

Phase

Hertz

Pr. Classification

Seal Support

Cooling Coil

Yes
No

ANSI/API Plan

Barrier Fluid

Pressure

Temperature

Other Seal Requirements

Other Requirements