Dealer Purchase Order Form

*AN ORDER SENT THROUGH THIS FORM IS A FINAL CONFIRMED ORDER*
And will go directly to Shipping to be processed.

Type number needed in “Quantity” and click “Tab”. The total at the bottom will update.

Prices are MSRP.

Your dealer discount will be subtracted and shipping added to your invoice.

*PLEASE MAKE SURE YOU FILL OUT THE FIRST FIVE REQUIRED FIELDS*

THIS PAGE COVERS ALL COMMON VARIATIONS

For items not listed here, please specify in the notes field.
Or you can use the Dealer Request a Quote form.

INCLUDED WITH PUMP ORDER at no charge

Connection options: 3/4” hose, 90-degree spout, and NPT threading on the output port.
Rod extenders. (for 8 or more sections), for a possible adjustment to total sucker rod length.
Roll of Teflon tape. (DO NOT USE PIPE DOPE.)

Shipping (one pump) is approximately:

West of Mississippi: 1-24 drop pipes $145: 25+ DP $240
East of Mississippi: 1-24 drop pipes $165: 25+ DP $260

Company Name

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Tracking Code (Reference Name or Number)

Order notes?

Parts

Part

Quantity

Calculated Price ($)

Pump Head

PHA-2: Pump Head Assembly. For casing 12”+ above grade.

Price: $575

PHA-2: Pump Head Assembly. For casing 12”+ above grade. Price: $575 Quantity

PHA-2: Pump Head Assembly. For casing 12”+ above grade. Total Price

PHA-47-2: Pump Head Assembly. Double-height for casing lower than 12”.

Price: $675

PHA-47-2: Pump Head Assembly. Double-height for casing lower than 12”. Price: $675 Quantity

PHA-47-2: Pump Head Assembly. Double-height for casing lower than 12”. Total Price

PHA2-ME/GM: For HD handle.

Price: $440

PHA2-ME/GM: For HD handle. Price: $440 Quantity

PHA2-ME/GM: For HD handle. Total Price

Handle Assembly

24LA: 24” Handle.

Price: $72.50

24LA: 24” Handle. Price: $72.50 Quantity

24LA: 24” Handle. Total Price

36LA: 36” Handle.

Price: $95.00

36LA: 36” Handle. Price: $95.00 Quantity

36LA: 36” Handle. Total Price

36LA-HD: 36" Heavy-duty Handle: Village or extreme use.

Price: $440.00

REQUIRES PHA2-ME/GM above.

36LA-HD: 36" Heavy-duty Handle: Village or extreme use. Price: $440.00 Quantity

36LA-HD: 36" Heavy-duty Handle: Village or extreme use. Total Price

Well Caps

C2-Assy: 2” well cap. (2” casing MUST be reinforced).

Price: $72.50

C2-Assy: 2” well cap. (2” casing MUST be reinforced). Price: $72.50 Quantity

C2-Assy: 2” well cap. (2” casing MUST be reinforced). Total Price

C4-Assy: 4” Three ports.

Price: $85.00

C4-Assy: 4” Three ports. Price: $85.00 Quantity

C4-Assy: 4” Three ports. Total Price

C4.5-Assy: 4.5” Three ports.

Price: $85.00

C4.5-Assy: 4.5” Three ports. Price: $85.00 Quantity

C4.5-Assy: 4.5” Three ports. Total Price

C5-Assy: 5” Four ports.

Price: $85.00

C5-Assy: 5” Four ports. Price: $85.00 Quantity

C5-Assy: 5” Four ports. Total Price

C5.5-6.25/4-Assy: For casing with 5.5"ID. Three ports.

Price: $115.00

C5.5-6.25/4-Assy: For casing with 5.5"ID. Three ports. Price: $115.00 Quantity

C5.5-6.25/4-Assy: For casing with 5.5"ID. Three ports. Total Price

C6-6.25-Assy: For 6” and 6.25” casings. Four ports.

Price: $105.00

C6-6.25-Assy: For 6” and 6.25” casings. Four ports. Price: $105.00 Quantity

C6-6.25-Assy: For 6” and 6.25” casings. Four ports. Total Price

C6-6.25-4Assy: For 6” or 6.25” casing with 4" liner. Four ports.

Price: $115.00

C6-6.25-4Assy: For 6” or 6.25” casing with 4" liner. Four ports. Price: $115.00 Quantity

C6-6.25-4Assy: For 6” or 6.25” casing with 4" liner. Four ports. Total Price

Pitless Well Caps

C5WTCC-CI: 5” (5-5/8” OD casings).

Price: $120.00

C5WTCC-CI: 5” (5-5/8” OD casings). Price: $120.00 Quantity

C5WTCC-CI: 5” (5-5/8” OD casings). Total Price

C6WTCC-CI: 6” (for 6” or 6.25” ID casings with 6-5/8” OD).

Price: $130.00

C6WTCC-CI: 6” (for 6” or 6.25” ID casings with 6-5/8” OD). Price: $130.00 Quantity

C6WTCC-CI: 6” (for 6” or 6.25” ID casings with 6-5/8” OD). Total Price

C7WTCC-CI: 6.25” (6.9-7” OD casing).

Price: $140.00

C7WTCC-CI: 6.25” (6.9-7” OD casing). Price: $140.00 Quantity

C7WTCC-CI: 6.25” (6.9-7” OD casing). Total Price

TOP PIPE/ROD SECTION, OR PITLESS ADAPTOR

109DPTSS-48: 9.0’ top drop pipe kit. Weep hole at 48".

Price: $50.00

109DPTSS-48: 9.0’ top drop pipe kit. Weep hole at 48". Price: $50.00 Quantity

109DPTSS-48: 9.0’ top drop pipe kit. Weep hole at 48". Total Price

109DPTSS-72: 9.0’ top drop pipe kit. Weep hole at 72".

Price: $50.00

109DPTSS-72: 9.0’ top drop pipe kit. Weep hole at 72". Price: $50.00 Quantity

109DPTSS-72: 9.0’ top drop pipe kit. Weep hole at 72". Total Price

54DPTSS-48: 54" top drop pipe kit. Weep hole at 48".

Price: $45.00

54DPTSS-48: 54" top drop pipe kit. Weep hole at 48". Price: $45.00 Quantity

54DPTSS-48: 54" top drop pipe kit. Weep hole at 48". Total Price

PA-1: Pitless Adaptor.

Price: $275.00

PA-1: Pitless Adaptor. Price: $275.00 Quantity

PA-1: Pitless Adaptor. Total Price

DROP PIPE / ROD SECTIONS

109DPSS: 9.0’ drop pipe kit

Price: $50.00

109DPSS: 9.0’ drop pipe kit Price: $50.00 Quantity

109DPSS: 9.0’ drop pipe kit Total Price

54DPSS: 54” drop pipe kit

Price: $45.00

54DPSS: 54” drop pipe kit Price: $45.00 Quantity

54DPSS: 54” drop pipe kit Total Price

27DPSS: 27” drop pipe kit

Price: $40.00

27DPSS: 27” drop pipe kit Price: $40.00 Quantity

27DPSS: 27” drop pipe kit Total Price

PUMP CYLINDERS

125CA-82515 Pump Cylinder. (8.5oz per full stroke.)

Price: $400.00

125CA-82515 Pump Cylinder. (8.5oz per full stroke.) Price: $400.00 Quantity

125CA-82515 Pump Cylinder. (8.5oz per full stroke.) Total Price

100CA Pump Cylinder. (4.5oz per full stroke.)

Price: $330.00

100CA Pump Cylinder. (4.5oz per full stroke.) Price: $330.00 Quantity

100CA Pump Cylinder. (4.5oz per full stroke.) Total Price

ACCESSORIES

SK125-82515: Seal kit

Price: $30.00

SK125-82515: Seal kit Price: $30.00 Quantity

SK125-82515: Seal kit Total Price

SK100BU: Seal kit

Price: $25.00

SK100BU: Seal kit Price: $25.00 Quantity

SK100BU: Seal kit Total Price

CV-1-Kit: One-way check valve, with pressure gauge

Price: $75.00

CV-1-Kit: One-way check valve, with pressure gauge Price: $75.00 Quantity

CV-1-Kit: One-way check valve, with pressure gauge Total Price

SIM073: Safety Tool

Price: $28.00

SIM073: Safety Tool Price: $28.00 Quantity

SIM073: Safety Tool Total Price

TH-1Assy: T-Handle Installation Assist Tool

Price: $12.00

TH-1Assy: T-Handle Installation Assist Tool Price: $12.00 Quantity

TH-1Assy: T-Handle Installation Assist Tool Total Price

SIM082 T6061 mounting plate with mounting bolts and split flange kit

Price: $115.00

SIM082 T6061 mounting plate with mounting bolts and split flange kit Price: $115.00 Quantity

SIM082 T6061 mounting plate with mounting bolts and split flange kit Total Price

Total

Total Price

Dealer Purchase Order Form

Parts

Pump Head

Handle Assembly

Well Caps

Pitless Well Caps

TOP PIPE/ROD SECTION, OR PITLESS ADAPTOR

DROP PIPE / ROD SECTIONS

PUMP CYLINDERS

ACCESSORIES

Total

About Us

Office

Contacts

Dealer Purchase Order Form

Parts

Pump Head

Handle Assembly

Well Caps

Pitless Well Caps

*TOP* PIPE/ROD SECTION, OR PITLESS ADAPTOR

DROP PIPE / ROD SECTIONS

PUMP CYLINDERS

ACCESSORIES

Total

TOP PIPE/ROD SECTION, OR PITLESS ADAPTOR