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Depco Pump Company
Phone   (727) 446-1656   (800) 446-1656
Fax   (727) 446-7867
Email sales@depcopump.com

Name _____________________________________________

Company Name _____________________________________

Phone _____________________________________________

Fax _______________________________________________

Email _____________________________________________

Briefly describe your pumping needs.

Are you replacing an existing pump?     YES    NO

If YES please give us any applicable details such as existing brand and model number,
connection size and style, material of construction, conditions of service, serial number etc.

Describe the liquid(s) being pumped.

What flow is required?

What is the Total Discharge Pressure or Total Dynamic Head required?

Is the liquid source below the pump inlet?    YES   NO

If YES, how far below?

Please describe any solids that are in the liquid by type, size and concentration.

Temperature of liquid being pumped.                 F°    C°

Is the liquid flammable?     YES    NO

Viscosity of liquid if applicable.

Specific gravity if applicable.

What type of pump drive is required? Is it electric, hydraulic, air motor, gas engine etc?

If an electric motor is required please describe any details such as duty cycle, motor enclosure,
voltage required, AC or DC, phase, hertz etc.