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New Pump Application

Representative Name (*)
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Application Name (*)
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Date (*)
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Business Name (*)
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E-Mail (*)
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Address (*)
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City (*)
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State/Providence (*)
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Zip Code (*)
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Telephone (*)
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Fax
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Quanity (*)
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Equipment (*)
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Brand
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Model
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Size
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Impeller Diameter
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Motor HP
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RPM
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Frame
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Other
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Pump Metallurgy (Wet End)
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Seal Configuration
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Shaft Orientation (*)
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History/Problems or issues with pump
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Image 200kb limit
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Supply Motor Description
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Supply Baseplate Description
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Liquid Pumped
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Solids
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Solid Size
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Concentration WGT%
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Temperature (F)
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Specific Gravity
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Viscosity
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Vapor Pressure
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Suction Pressure
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Discharge Pressure
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Flow GPM
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Head (Ft)
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NPSHA (Ft)
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Electrical
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Volts
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Phase
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Hertz
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Pr. Classification
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Seal Support
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Cooling Coil
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ANSI/API Plan
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Barrier Fluid
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Pressure
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Temperature
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Other Seal Requirements
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Other Requirements
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