Aquzar Inquiry & Stage 1 Project Accessment Form

Aquzar Inquiry & Stage 1 Project Accessment Form

Please fill out the following form to help us evaluate your project requirements:(Fill out where relevant. Mark N/A where not relevant, mark 'TBA' if details not yet known)
1. Client*

First NameLast Name
2. Email Address*
example@example.com
3. Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
4. Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Internet Search/Social MediaPrevious or Current ClientAvanza Team MemberReferral Team Member
6. Name Of Referrer (if not internet based)
7. Brief Description and Address of Business, Industry or Project For Aquzar. Please include County and State*
Residential housing, ApartmentsHotelBar RestaurantMixed CommercialRV Park, Resort, GlampingVillage, Town, CityWork Site, Work CampCommercial Cooking Taking Place, Restaurant, Canteen ETC
9. Est Number of Structures or Units to be serviced by Aquzar
10. Est Number of Persons to be serviced by Aquzar
Site and Architectural PlansPlanning SummisionsBuilding EntitlementsBuilding PermitsWastewater Permits
6 - 12 Months1- 2 years2 Years +
New TemporaryNew PermanentUpgrade or Replacement of Existing EquipmentAbove groundPartially BuriedBuried to Lid LevelHoused Independently
YesNoN/A
15. If yes Above : Daily Flow Numbers US Gallons
GravityPumpedN/A
SoakawayWatercourseNot Decided
Combined Sewage & Surface WaterSewage Only
18. Do you Know Temperature Range or Weather Related Factors?
19. Any Further Relevant Site or Project Details or Comments at This TIme?