Order Pumps or Request Pump Quotation

       

Your Name:
Your Title:
Company Name:
Address:
City:
State/Province:
Zip/Postal Code:
Country:	U.S. Argentina Australia Belgium Brazil Canada Chile China Denmark England France Germany Holland Iceland India Indonesia Italy Japan Korea Mexico Morocco New Zealand Pakistan Peru Philippines Poland Romania Russia Singapore South Africa Taiwan Thailand Turkey Venezuela Zambia Other (Specify in Comments.)
Your E-mail address:	Example: yourname@isp.com
Area Code and Phone Number: If you're outside of the U.S., please enter your country and city codes.	Examples: 706.863.1011 or 011.39.81.556.7888
Area Code and Fax Number: If you're outside of the U.S., please enter your country and city codes.

                                                                                                                                                          

Response Requested By:	Example: 09/15/01
Equipment Location:
Slurry  ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~
Slurry Description:	Aluminum Coal Copper Iron Ore Gold Sand Other (Specify in Comments.)
If Type of Slurry is "Other," please specify:
Service Description:	Cyclone Feed Mill Discharge Screen Feed Tailings Transfer Other (Specify in Comments.)
If Service Description is "Other," please specify: (Space limited to 25 characters.)
Solids SG:
Cw, % solids by weight:
Average (d50) particle size:
d85 Particle Size (if known)
Maximum Particle Size:
Special characteristic: Include information on pH, temp., viscosity, froth, chlorides...(Space limited to 300 characters.)
System  ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~
Flow:	gpm l/sec m3/h
Head (TDH):	feet meters
Describe system, pump or application concerns: (Space limited to 300 characters.)
Motor  ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~
Motor enclosure:
Electrical Source (Phase/hertz/voltage):
Preferred Motor RPM:
Elevation:
Is variable speed required?	Yes No
Other special requirements: (Space limited to 300 characters.)
Drive  ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~
Should GIW quote drive?	Yes No
V-Belt Design:	Fixed Speed Timing Belt/HTD Drives Variable Pitch
If V-Belt Design is Fixed Speed, what type is it?	Select Individual Banded
V-Belt Motor Mount Arrangement:	Select Horizontal Overhead Reverse Overhead
Direct Drive Design:	Select Pump to motor Pump, gear reducer to motor Pump, gear reducer, fluid drive to motor
Other Information  ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~
Will this pump replace an existing pump?	Yes No
If this pump will replace an existing pump, complete the next seven questions. If no, go to "Describe Operational Problems."
Manufacturer:
Size/frame:
Motor HP:
Pump RPM speed:
Discharge position:
Impeller diameter:	inches millimeters
Describe operational problems: (Space limited to 300 characters.)
Comments: (Space limited to 300 characters.)

Use this form to order pumps or to request a pump quotation.

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