ScrubSeal Application quote form

ScrubSeal™ Valve Application Questionnaire.

* Areas marked with a red asterisk are required.

The following Questionnaire should be filled out as completely as possible to help us understand the requirements of your application so we can propose the most suitable ScrubSeal™ Valve.

Address Proposal To:

* Name:

* Title:

* Company Name:

* Address:

* City:

* State:

* Zip:

* Country:

* Phone:

* E-mail:

* Proposal Required By This Date:

Briefly describe the application:
What is the liquid being handled?
What is the flow rate through the line?	GPM
What is the temperature of the liquid?	°F
Does the liquid adhere to surfaces (is it of a sticky nature):
What is the negative pressure in the vessel:	ins. w.c.
What is the pressure at the discharge point:	ins w.c.
Any other comments:
Where did you hear about ScrubSeal™:

Please enter the following