LobePro Municipal 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 - Select Option that best describe the material from the drop-down. Additional information can be added in the Job Information box below.
Fluid Temperature (Lowest) Specific Gravity of Fluid
Fluid Temperature (Highest) Percentage of Solids by Weight
Max. Hard Solids Size Sand and Grit % by weight present (Grit limit is 1% maximum)
Max. Soft Compressible Solids Size Estimated Rags and/or Fiber in Sludge
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: How many pumps are required?
Discharge Lift (if applicable): New Installation or Replacement Unit?
If Replacement, list reason for replacement or current issues with application?(Use space below if needed.)
OTHER SPECIAL APPLCATION CONCERNS/NOTES
If you have any other special concerns that need to be addressed,
please list the information here.
GENERAL NOTES (Please use this space for drawings or any other information not covered above.)