Customer Data:

Your Name (required)

Your Email (required)

Company Name:

Title

Phone Number :

Fax Number :

EQUIPMENT DATE:

Equipment Description :

Equipment Model no :

Is Pump Split? (Solid/Hariz./Vertical) :

Pump number of stages (If multistage) :

Pump Type: (Overhang/Double End) :

Is cooling jacket present (Yes/No) :

Type & Model of Current Seal :

OPERATION CONDITIONS

Process Fluid

Temperature (F or C) :

Concentration :

Pressure (psi or Bar) :

Seal Chamber Pressure :

Pump Section Pressure :

Pump Discharge Pressure :

Speed (RPM) :

FLUID CHARACTERISTICS

pH value

Specific Gravity :

Vapor pressure :

Are Solids Present? (Yes/No) :

Does Fluid Set up/Harden? (Yes / No) :

Is Fluid Toxic? (Yes/No :

Is Fluid Corrosive? (Yes / No) :

Product Photo :

If Any Comment:

EQUIPMENT DIMENSIONS

Shaft O.D (Size & Tolerance) :

Sleeve O.D. (Size & Tolerance)

Seal Chamber Depth (if stepped provide drawing) :

Register I.D. (Size & Tolerance) :

Distance to Shaft Step :

Distance to End of sleeve :

Distance to first obstruction :

Maximum Gland O.D :

18+3=21