MD/RD RFQ - Formstack

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Fields

All Fields with * must be completed

Contact Name*

Title*

E-mail*

Phone*

Company

End User

Requested Information

Request Pricing?

Yes No

Request Samples?

Yes No

Sample Quantity

1 2 3

Other: Other Value

Price Levels

1,20,25,50 100,250,500 1000,2500

Other: Other Value

Check all that apply

Target Pricing

Delivery Date:

Annual Quantity

Year 1:

Annual Quantity

Year 2:

Annual Quantity

Year 3:

Project Information

Project Name

Application*

Circulation, Filtration, Chiller, etc

Pump Specification

Discharge Capacity: Normal*

Specify LPM or GPM

Capacity Min

LPM or GPM

Capacity Max

LPM or GPM

Discharge Pressure: Normal*

Specify PSI or MPa

Pressure Min

PSI or MPa

Pressure Max

PSI or MPa

Liquid:

Liquid Type*

Temperature*

Specific Gravity

Concentration

Viscosity

Vapor Pressure

Operating Conditions:

Ambient Environmental Temperature

Relative Environmental Humidity

Installation Location

Indoor Outdoor

Continuous Duty Cycle

Hrs/Day

Intermittent Off Time

Intermittent On Time

Imtermittent Times/Day

Motor:

Voltage*

12 VDC 24 VDC 115 VAC 230 VAC

Other: Other Value

Type

Fixed Variable

Make/Preference

Phase/Hz*

Amp Limits

Speed Control

Yes No

Reduction Ratio/NR

Control Interface

Terminal/Connectors

Required N/A

Make

Name/Model

Wire Length

Pump Configurations:

Housing Material

Port Connections

Vibration/Noise Level

Standards

UL EU Dir RoHs

Other: Other Value

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