Application Questionnaire

Basic Project Information
Your Name
Phone Number
Email
Company Name
Project Name or Nickname
Provide a general description of the application
Site Location
Name of WaterSurplus Contact:
Next Step for Pricing:

Budgetary Estimate for FundingFirm Proposal (Funding Available)
Pricing Due Date

MonthDayYear

Equipment Selection
What type of equipment components are required (if any)?
Interested in (select all that apply):

Renting EquipmentPurchasing New EquipmentPurchasing Used EquipmentPilot Study
What is the rental term?
What is the pilot term?

Water Quantity

Enter information about the amount of water needed.

Product Water Requirements:

	Minimum	Maximum
Product Water Generation [gallons per day]
Water Distribution Flowrate [gallons per minute]

Hours of operation?
Select how many hours per day
Is a storage tank available for product water?
Enter size in gallons
What product water pressure is required?
What is the product water line size?
Provide details to clarify these water generation, water storage, or distribution flowrate requirements:

Water Quality

Enter information about your feedwater (analysis required) and the product water needed:
What is the source of the feedwater
What is the Maximum feedwater temperature?
For Example, during Summer
What is the Minimum feedwater temperature?
For Example, during Winter
Provide a brief description of the application and intended use of treated water:

Water Quality

Water Analyses may be uploaded document(s) or manual entry:
Document Upload:

Cancelof

Manual Entry:

	Feedwater	Final Requirement	Units
Calcium (Ca)*
Magnesium (Mg)*
Sodium (Na)*
Potassium (K)*
Fluoride (F)*
Manganese (Mn)*
Barium (Ba)*
Strontium (Sr)*
Aluminum (Al)*
Ammonia-N (NH4)*
Iron (Fe)*
Chlorine (Cl2)
Chloride (Cl)*
Sulfate (SO4)*
Nitrate (NO3)*
Phosphate (PO4)*
Boron (B)*
Carbonate (CO3)*
Bicarbonate (HCO3)*
Total Alkalinity*
Silica (SiO2)*
Oil & Grease
TDS*
Conductivity*
TSS*
pH*
Turbidity*
SDI
Total Hardness*
TOC*
Bacteria

Utilities
What is the feedwater pressure?
What is the drain size & capacity?
Single-Phase Power Available:

120 VAC / 1 PH / 60 Hz208 VAC / 1 PH / 60 Hz230 VAC / 1 PH / 60 Hz
Three-Phase Power Available:

230 VAC / 3 PH / 60 Hz460 VAC / 3 PH / 60 Hz480 VAC / 3 PH / 60 Hz
Is Clean, Dry Control Air Available?

Execution
Required system startup date?

MonthDayYear
Who is responsible for transportation?
Is start-up and training required?
What type of installation is required?
Where will the equipment be installed?

Installation Site

	Length [ft]	Width [ft]	Height [ft]
Installation Space

Installation Site Access

	Width [ft]	Height [ft]
Doorway or Entry Access Restriction

Your Existing Equipment

WaterSurplus may be willing to purchase your existing equipment.
Is your company interested in selling the existing equipment to WaterSurplus?
Should be Empty: