Pulsation Stabilizer Inquiry Form - Waterflood Service & Sales LTD.

Customer (required):

Attention:

Address:

City:

Province/State:

ZIP/Postal Code:

Phone:

Fax:

Cell:

E-mail (required):

Sales Contact:

Site Location:

Site LSD:

Make

Model

Duplex Triplex Quintuplex

RPM:

Stroke:

Bore:

Connection Type: Flanged Threaded

Suction Pressure

Suction Line Size

Flange Rating if Applicable: #ANSI

Discharge Pressure

Discharge Line Size

Flange Rating if Applicable: #ANSI

What kind of fluid is being pumped? #ANSI

End destination of stabilizers (what country): #ANSI

Delivery Date Requested:	Trucking: WSS Other
	Loading: WSS Other

Purchase Lease to Purchase Rent