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Customer Information * indicates a required field
Name:*
Email Address:*
Phone #:*	Fax #:*
Company/ Division:*
Address:*
Type of Business:
Engineering Contact:
Phone #:
Purchasing Contact:
Phone #:
Fax #:
Application Information
Application:	Pump Motor Other
Describe:
Existing Application:	Yes No
If Existing, change is due to:	Performance Price Package Size
Estimated Annual Production Requirements:
Application Requirements Application Constraints - Please include english or SI units
Design Flow:	lpm gpm at  RPM
Flow Range:	Min  to Max lpm gpm
Speed Range:	Min  Max
Pressure Range:	Min  to Max Kpa Psi
Lift:	mm in
Fluid:
Viscosity:	cP Sus at  C° F°
Temperature Range:	Min  to Max   C° F°
Packaging Constraints
Min. I.D.:	mm in
Max. O.D.:	mm in
Max. Thickness:	mm in
Housing material:
Action Requested	Standard gerotor recommendation requested New gerotor geometry design requested Design recommendation requested Complete pump design requested Complete motor design requested
Comments: