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Date:
Company:*
Contact Name:*
Address:
City:
State:
Phone:*
Fax:
Email:*

Pump Item No.:
Pump Quantity:

Liquid Description:*
Liquid Concentration:
Temperature:		(Specify F or C)
Specific Gravity:
Viscosity:		(Specify SSU, cps, etc)

Solids Type:
Solids Concentration:
Particle Size:

Flow:		(Specify gpm or m3/hr)
Total Dynamic Head:		(Specify feet or meters)

NPSH-A:		(Specify feet or meters)

Mechanical Seal
Prefer Single or Double:
External Water Flush:	yes no

Coupling Required:	yes no
Baseplate Required:	yes no

Motor Required:	yes no
Motor Enclosure:		(TEFC, Explosion proof, etc.)
Supply:		(Volts/Hz/ph)
Operation:		(Continuous or Intermittent)

Comments

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FRIATEC N.A., LLC | 11108 Challenger Ave., Ste 1, Odessa, FL 33556 USA
TOLL FREE: 866-869-0880 | Ph: 727-753-0880 | Fax: 727-753-0886 | Email: info@friatecna.net