1. Job Name:
2. Job Location:

3. List the fixtures that are included in this job: ...Example: 2 toilets, 2 tub/showers, kitchen sink w/ disposer, laundry, etc.
4. What size discharge pipe will lead from the pump?
5. What is the static head (how high) that the pump will have to lift?
6. List all the fittings that will be included on the discharge line: ...Example: 2 - 90's; 2 - 45; 1 tee, 2 checks, etc.
7. How many feet of pipe will be included on the discharge line?
8. What is the electrical supply for the pumps (voltage and phase)?
9. What size basin is needed (if known)?

10.Will it be an indoor or outdoor system?	indoor	outdoor
11. Is this new construction or a replacement?	new construction	replacement
12. Is this a Simplex or Duplex?	Simplex	Duplex

13. What is the name of the plumbing contractor?

14. Additional Comments:

Additional Information:

Your Name:
Company Name:
Phone Number:
Email Address:

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Please call Chris Roeder at 303-289-4191 ext. 31 so the he can help you out!