EXPRESS QUOTE REQUEST FORM
CONDENSATE PUMP REQUEST FORM

Power Plus International
Ph: 1-800-780-3776
Fax: 770-957-9563
 

Brand Name: ___________________________________________
Model #: _______________________________
Serial #: _______________________________
GPM: ____________
Ft of Head: ____________
-or-  
PSI: ____________
Material of tank: Cast Steel
  Cast Iron
  Stainless Steel
HP of Motor: ____________
Voltage of Motor: ____________
Hz of Motor: ____________
RPM: ____________
Simplex / Duplex: ____________
Any other items you may need on the tank:
Name: _____________________________________________
Company: _____________________________________________
Phone: _______________________________
Fax: _______________________________

Fax this Form to 770-957-9563
Power Plus International