Filtration Product Requirement Form
Please fill out all fields below.
Customer Information
Company Name:
Contact Name:
Street Address:
Email:
City/State/Zip:
Phone:
Industry:
Select One
Aerospace
Air, Soil and Water Quality Services
Amusement and Recreation Services
Analytical and Instrumentation
Architecture/Engineering
Biotech/Pharmaceutical
Chemicals and Allied Products
Construction
Durable Goods, Resellers
Educational Institutions
Electric and Gas Utilities
Fabricated Metal Products
Food, Beverage and Related Products
Machinery, Except Electrical
Medical and Other Health Services
Metal Mining
Miscellaneous Manufacturing Industries
Oil & Gas Extraction Production/Pipeline
Paper, Pulp and Wood Products
Petroleum Refining and Coal Products
Plastic and Rubber Products
Research/Testing
Semiconductor/Microelectronics
Stone, Clay and Glass Products
Transportation
Water Treatment and Sanitary Services
Other
Fax:
Filter Application Data
Fluid & Particle Description:
Particle Size Range:
Flow Rate:
Temperature:
System Pressure:
Maximum Initial Pressure Drop:
Current Filter - For Existing Applications
Manufacturer:
Part Number:
Approximate Annual Usage:
Current Filter Housing - For Existing Applications
Manufacturer:
Part Number:
Approximate Annual Usage:
Please explain any special requirements needed for your application: