Name:

Company:

Address:

City:

State:

Zip/Postal Code:

Country:

Telephone:

Fax:

Email:

Would you like more information about AmeriChem?

Yes

No

Would you like a sales representative to contact you?

Yes

No

Questions/Comments:

*If you have a specific inquiry, please fill out the form below*

Fluid:

S.G.:

Filter Required?

Operating Temperature:

Electrical:

Yes

No

F˚

Micron Rating:

Operating Pressure:

Voltage:

PSI

Phase:

Operating Flow:

Tank Required?

Yes

No

GPM

Hz:

Viscosity:

Tank Size:

Area Classification:

Cps

Gal

Maximum Temperature:

Vertical

Horizontal

F˚

Pressure Rating:

Notes:

Maximum Pressure:

PSI

Preferred Material:

Maximum Flow:

GPM

Level Gauge?

Yes

No

Pump Required?

Yes

No

Level Switches:

Qty

Mixer Required?

Transfer

Metering

Yes

No

Suction Pressure: