Motor/Pump Assembly Worksheet Name* First Last Email* Company* Phone*Application*Qty. Required NowInitial Requested Lead-TimeDelivery Date Day Month Year FlowFlow*@ required Input SpeedFlow Measurement* US GPM L/Min Operating PressureNumber*Measurement* PSI BAR @ % Time (Total should =100)* NumberMeasurement PSI BAR @ % Time (Total should =100) NumberMeasurement PSI BAR @ % Time (Total should =100) NumberMeasurement PSI BAR @ % Time (Total should =100) Duty CycleHours/DayHours/WeekPowerkW Required*Drive Power Limitation? No Yes - Specify kW Max in 'Other' box below Power SourcePower Source (If Known)* Current* AC DC Input SpeedSafe or Hazardous AreaArea* Safe Hazardous - Specify Zoned Area SpecifyFluid TypeFluid Type* Supply Technical Data Sheet if Special Fluid.Ambient TemperatureMAX TemperatureTemperature Scale* ºF ºC MIN TemperatureTemperature Scale* ºF ºC MountingMounting* Vertical Horizontal SpecificationsDoes the assembly need to meet a particular specification?Specification Yes No If NO, standard motor pump will be quoted.List specification(s)Preferred Motor Supplier?Supplier Yes No List Supplier(s)PaintRequired Yes No If NO, unit will be supplied unpainted.Give DetailsSupply spec as required.Attach a File Drop files here or Select files Accepted file types: txt, doc, docx, pdf, png, jpg, tif, Max. file size: 128 MB. EmailThis field is for validation purposes and should be left unchanged.
