Application and Sizing Survey

Note: Although it is most unlikely that you will experience any problems responding to this survey, certain non-standard browsers will not respond properly. If you experience any difficulties, (or if you are not using a forms-capable browser) you can respond by calling 1-800-484-8324 code 2081, by fax at (561) 362-6338 or send all relevant information by email to info@culliganflorida.com
What is the general nature of your business? Please specify.
(i.e. hotel, electronics manufacturer, dialysis center, plantation) 


What is the intended purpose for the treated water? Please specify.
 


What is the source of your current water supply?

City          River          Cistern

Well          Lake          Other

Please describe the problems and/or symptoms you now experience with your current water supply.
                                                                                                                                         

  Discoloration          Poor Taste          

Odor          Scale         Other


How many hours per day will you use the treated water:
          8 Hours             12 Hours         

16 Hours          24 Hours    Other

How many days per week will you use the treated water:
       4 Days            5  Days         

6 Days          7  Days     Other

What is the approximate flow rate of water you will require?
(Approximate gallons or litters per minute)

What is the approximate number of total gallons or litters
you will require in a 24 hour period?


Which system of measurement do you work with? U.S. Metric Imperial

Would you describe your treated water flow need as: Peak Continuous
"Peak" means you tend to need water fast for a short time such as filling a bucket.
"Continuous" means you tend to need a regular stream or flow over a longer time
such as a continuous feed to a rinse line.


What is the available power source?
(Please include voltage)


Do you already have water analysis information available? Yes No

If yes, please enter results here or send it to us by fax at (561) 362-6338: 


If you've never had a proper water analysis conducted, we strongly urge you to do so.
For your convenience, you may order a water testing kit directly from us.

Name
Company
Address
City
State      Zip
E-mail
Phone #
Fax # 

           
Please enter any additional comments or questions here: