Dealer Quote Request

IF YOUR COMPANY IS NOT A DEALER BUT WOULD LIKE TO BE

Please fill out the Become a Dealer form first, then complete this quote request form.

Company Name

First Name

Last Name

Phone/Mobile

Country

State/Territory

Province/Territory

State/Province/Territory

Zip

Tracking Code (Your Customer's Name)

What is the static water level (in feet)

The static water level measurement is:

Estimated

Measured

Is there a pump in the well now?

Please add details about a pump in the well.

What is the Position/set of the current pump (in feet)?

What is the depth of the well (in feet)

What is the Recovery Rate of the well?

What is the Freezing level / frost line? (in inches)

Where is your well?

What is the inside diameter of the casing?

Casing Inside Diameter Other

What is the casing rise above ground level?

Are you going to pump to a pressure tank? (now or future)

YES

DEFINITELY NEVER

Is there any vertical rise from the well head up to the point of delivery?

Are you interested in adding a motor? (now or future)

Yes

What is your motor interest?

Do you have any questions or additional information you think would be useful?

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