LobePro Industrial Pump Application Form
2610 Sidney Lanier Drive, Brunswick, Ga. 31525
Tel: 912-466-0304 | Fax: 912-466-0086 | 1-888-997-PUMP | www.LobePro.com
BUSINESS NAME: DATE QUOTE REQUESTED:
CONTACT PERSON: DATE QUOTE REQUIRED:
ADDRESS: DISTRIBUTOR NAME (if needed):
DISTRIBUTOR CONTACT:
PREFERED CONTACT METHOD:
TELEPHONE: Would like a sales representative or our engineering department to contact you about your application?
FAX:
E-MAIL: Yes No
INFORMATION ABOUT THE MATERIAL TO BE PUMPED (Metric Options Available in Dropdown menus. Related cells are linked.)
Material Pumped
Viscosity (Lowest) Abrasives (Examples in Parenthesis)
Viscosity (Highest) Specific Gravity of Fluid
Fluid Temperature (Lowest) Vapor Pressure
Fluid Temperature (Highest) pH Value (1 to 14)
Max. Hard Solids Size Suspended Solids Percentage by Weight
Max. Soft Compressible Solids Size Dissolved Solids Percentage by Weight
PUMP APPLICATION / CONDITION OF SERVICE (Metric Options Available in Dropdown menus. Suction and Discharge Conditions are linked.)
Job Information/ General Description:
Flow Capacity Required: Discharge Pipe (Size/Length)
Suction Pressure: Suction Pipe (Size/Length):
Suction Lift (if not flooded): Hrs Per Day Pump will run
Discharge Pressure Required at Pump: If Fluid Shear Sensitive?
Discharge Lift (if applicable): How many pumps are required?
Will occasional "washing/cleaning, flushing, back washing" be performed on the pump? Yes Pump Cleaning New Installation or Replacement Unit?
No Pump Cleaning If Replacement, list reason for replacement or current issues with application?(Use space below if needed.)
If yes, briefly explain and note chemicals used that may affect pump materials.
OTHER SPECIAL APPLCATION CONCERNS/NOTES
If you have any other special concerns that need to be
addressed such as API 676 compliance, explosion proof motor
requests or any other information, add the information here.
GENERAL NOTES (Please use this space for drawings or any other information not covered above.)