| Applicant Information |
| First Name: * |
|
| Last Name: * |
|
| Address Street 1: |
(Optional) |
| Address Street 2: |
(Optional) |
| City: |
(Optional) |
| Zip Code: |
(5 digits)(Optional) |
| State: |
(Optional) |
| Contact Information |
| Daytime Phone: * |
|
| Email: * |
|
| Services Needed |
| Type Of Service: * |
|
| Date Needed: |
|
| Types of Service |
Air Driven High
Pressure Liquid Pumps: |
Model # (If Known):
|
| Oil or Oil/Water Service: |
PPO SeriesS Series
S-D SeriesLO Series |
| Water or Oil Service: |
PP SeriesPP-HL Series
L SeriesGX Series |
| Chemical Service: |
PPSF SeriesLSF Series
GX SeriesDC Series |
| Liquid Pump Air Pressure Available: |
|
| Liquid Pump Outlet Pressure Required: |
|
| Liquid Pumps Liquid Type: |
|
| Liquid Pump Flow Rate Required: |
|
| Full System Required: |
Yes |
| Portable/Mobile: |
Yes |
| |
|
| Air Driven Gas Booster: |
Model # (If Known):
|
| Single Acting - Single Stage: |
Yes |
| Double Acting - Single Stage: |
Yes |
| Double Acting - Two Stage: |
Yes |
| Gas Booster Air Pressure Available: |
|
| Gas Booster Air Volume Available (SCFM): |
|
| Gas Booster Outlet Pressure Required: |
|
| Gas Booster Minimum Gas Supply Pressure: |
|
| Gas Booster Maximum Gas Supply Pressure: |
|
| Gas Booster Flow Rate Required: |
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| Type Of Gas: |
|
| |
Intermittent DutyContinuous Duty |
| Full System Required: |
Yes |
| Portable/Mobile: |
Yes |
| |
|
| Air Pressure Amplifier: |
Model # (If Known):
|
| 2:1 Pressure Ratio: |
MPLV2 SPLV2 GPLV2 |
| 4:1 Pressure Ratio: |
MPLV4 |
| 5:1 Pressure Ratio: |
DLA5GPLV5 |
| Air Amplifier Air Pressure Available: |
|
| Air Amplifier Air Volume Available (SCFM): |
|
| Air Amplifier Output Pressure Required: |
|
| Air Amplifier Flow Rate Required: |
|
| |
Continuous DutyIntermittent Duty |
| Full System Required: |
Yes |
| Air Reciever Tank Size: |
1 Gallon4 Gallon10 Gallon
15 Gallon30 Gallon |
| Other Information |
|
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