Order Form

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In order that we can fulfill your order or request accurately, please complete the following form with as much detail as possible. This will enable our technicians to properly understand your requirements. Please fax or email this form to us for our immediate attention. Our fax number is (604) 881-7864.

Name
Title
Organization
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone
FAX
E-mail
URL

Describe your existing equipment & any problems you are currently experiencing
(please provide as much detail as possible):

Application
Liquid
Temperature
Specific Gravity
Vapor Pressure
Viscosity
pH
%Solids/wt.& Type/shape
Flow Rate
TDH
Suction Pressure
Discharge Pressure
NPSH Available
Suction Lift
Driver Type	(if motor, incl. frequency)
Powered by	(Diesel, Gas, Elec. Motor etc.)
If Electric Motor	(provide voltage AC or DC, 1ų or 3ų power, 50 or 60 cycle)