Request For Pump Quotation Form 00006 V1
Please complete this form so that ITS can determine the specific pump required and provide you with a quotation.
Customer Details
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Company Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Pump Details
Duty Cycle
Enter Figure Here
Enter Unit Here
Additional Information
Flow Rate
Diff Pressure
Product Name / Fluid Type
Product / Fluid Temperature
Product / Fluid Density
Product / Fluid Viscosity
Quantity of Pumps Required
Configuration Preferences
Pump Type
Please Select
Centrifugal
Lobe
Twin Screw
Circumferential piston pump
Eccentric Disc
Connection Type
Please Select
SMS
RJT
DIN
IDF
Clamp
Flange
Other
If 'Other' please state here:
Surface Finish
Please Select
1.6Ra
0.8Ra
0.5Ra
0.4Ra
Elastomer
Please Select
EPDM
FPM
NBR
FEP/PTFE
Mechanical Seal Type
Please Select
Single
Single Flush
Double Mechanical Seal
What Pump are you currently using and what issues are you having with it? This will help us to spec a pump that will resolve any problems you may be experiencing.
Any Additional Comments:
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