Application Questionnaire for Project Evaluation

  Name:                                                                               Title:

 Company:                                                                  E-Mail:

 Mailing Address:  

 City, State,Zip:

 Telephone No:                           Ext:           Fax No:

 Project Location:

 Business Type:

Select One from Menu Manufacturer Broker/Agent Consultant Distributor End User Engineer Other - Not Specified

 Primary Business Activity:

 Type of Project:

Select One from Menu Supply Water Purification High Purity Water Production Supply Water Treatment Wastewater Purification Wastewater Treatment Recycle/ReUse Material Handling Monitoring Process Controls Engineering OTHER - Not Specified

Scope of Project: (Check those items that best apply)   

  New Project      Modification      Replacement

 Waste or Supply Source:

 Capacity:      Average GPD (Gallons per Day)

      Average (Gallons per Week)              Peak GPM (Gallons per Minute)

  Current Treatment:                 

  List Objectives: