-
Fields marked with an * are required.
First Name* |
Middle Initial
Last Name*
|
Street Address* |
|
City* |
State/Province*
|
Country |
Zip/Postal Code*
|
Telephone Number |
-
-
Email*
|
|
What is it?* (as detailed as possible, include a sketch or diagram) |
|
|
Where does it apply?* (where in your system or company will it be used, such as distribution piping, maintenance, treatment plant, etc.) |
|
|
Who?* (who will use this item or who will approve its purchase) |
|
|
Why is it worth exploring?* (potential for cost/time savings, efficiency improvements, better safety, easier maintenance, nothing similar available, current items inferior, etc.) |
|
|
What is the estimated annual usage?* |
|
|
When will it be needed?* |
|
|
Sources for more information... |
|
|
|
|
Return completed form by mail or fax to:
Mueller Company
500 W. Eldorado St.
PO Box 671
Decatur IL 62522
FAX: (217) 425-7537
|