First Name:

Last Name:

Title:

Company name:

Company mailing address:

City:

State:

Country:

ZIP Code:

Telephone:

Fax:

E-Mail address:

Please use the space below to describe the equipment and conditions that now exist and/or specific improvements that are being sought.

Geographic area?
USA North East USA West Coast USA South West USA Mid Atlantic USA South East USA Mid West USA Mountain Europe Far East Asia Middle East Australia/NZ Central America South America Africa

What is the environment of the water treatment problem?
Residential
Commercial
Industrial
Mobile
Other environment:

What water treatment problems do you have?
Scale
Corrosion
Other problem:

What type of scale deposit do you have?
Calcium
Iron
Manganese
Silica
Boron
Chlorides
Other scale problems:

How long has there been a deposit problem, and to what degree (e.g., % of blockage, etc.)?

Source of water (well, municipal, pond, river, treatment plant, etc.):

Flow rate (gallons per minute, liters per minute, etc.):

pH:

Conductivity:

Calcium hardness (Parts per million):

Alkalinity (Parts per million):

Temperature (Degrees Fahrenheit):
(Degrees Fahrenheit):

If other fluid testing has been completed, please indicate the test results.