Pump Data Required
1	• Pump Make
	• Model Number
	• Material Of Construction
2	• Pump Type	Simplex Duplex Triplex Quadruplex
3	• Stroke Action	Single Double
4	• Volume	A) Discharge Flow max. gph/lph B) Stroke Per Minute C) Max Pump Working Pressure psi/kpa
		Liquid Data Required
1	Chemical Name	Concentration % Specific Gravity  Viscosity (c.p./ssu)
2	• Max Pumping Temperature	ºF ºC
		System Data Required
1	• System Operating Pressure	psi/kpa
		Pulsation Dampener Requirements
1	• Preferred Connection Size
2	• Port Connection Type	NPT BSPT Flange
3	• Material Of Construction	Wetted Bladder Non Wetted
4	• Canadian Registration Number    (CRN) required?	Yes No
		Contact Information
	• Company
	• Contact Name
	• Phone number:   (include area code)
	• Fax number:   (include area code)
	• E-mail address