Product Requests

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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) * (attach a sketch or diagram, if available)

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.... (attach source, if available)