Scientific Application Data Form (Pumps)

Quick Form (See below for full form)




Attachments: (Max. File Size: 10MB)

Your Message:

City:         State:       Zip Code:

Tel #:        Fax #:

Full Form

Description of Application

 New Application Replacement

Contact:*       Email:*

Current Pump being utilized:

Reason for Replacement:  Performance Delivery Quality Pricing

Prototype:            Quantity Required:       Date Prototype Required:

Production:          Annual Quantity:      Production Units Required:

General Description of Application:

Fluid Handled:      Fluid Viscosity:

Fluid Temperature:      Ambient Temperature:

Materials Compatible with Fluid:     Elastomers:

Plastics:       Metals:

Flow:              Dispense Volume: Microliters per stroke                Stroke Frequency: Cycles per min.

Acceptable Tolerance per dispense: %


Flow Rate: cc per min.            Are Flow Pulsations OK?

Acceptable Tolerance: %

INLET ConditionsOUTLET Conditions

Inlet Tubing I.D.                Outlet Tubing I.D.

Inlet Tubing Length:         Outlet Tubing Length:

Lift to Pump Inlet:            Head ON Pump Outlet:

Inlet Fitting:                      Outlet Fitting:

Pressure at Inlet:             Pressure at Outlet:

Outlet Pressure Required by Pump:

Voltage:                     Duty Cycle:

Physical Size Limits:            Height:           Width:                 Depth:  

Attachments: (Max. File Size: 10MB)