Company Name
        

      Your Name
        

      Street
      

      City
      

      State/Province
        

       Country
         

        Zip
        

        Phone if you would like to be contacted (best time)
        

        Email: Required
       

        Equipment wanted
         

DESCRIPTION OF WATER CONDITION

     Well Water, Municipal or Commercial Supply 

     Gallons Per Minute or  Water Pressure              

     Pump Type and HP    

IF YOUR UNSURE OF THE QUALITY OF YOUR WATER
ANALYZE IT WITH A HOME WATER TEST KIT

Summary of water analysis: 

(ppm) parts per million or (gpg) grains per gallon  

                             Bacteria 

                             Lead      

                             Nitrates  

                             Nitrites   

                             Chlorine 

                             Iron        

                             Copper   

                              pH         

                              Alkalinity

                              Hardness

                              Iron Bacteria

                              Hydrogen Sulfide