Application Data Form

*Your Name:

Your Job Title or Position:

Company Name:

*Business Phone:

*Email:

Fax:

I'm Interested in:

Address:

City:

State:

Zip Code:

Country:

------- TECHNICAL DATA -------

Application:

Line Size (inch):

Flow (gpm):

Pump Data (hp, rpm):

Pressure (psi):

Water Temp (F or C):

Available Head (ft):

Chemical Additives:

Sample & MSDS Sent/Date:

Describe
Process & Problem:

Additional Comments:

Copy the red characters and
paste them into the box.

To Send a SKETCH
PRINT OUT THIS FORM
Email a Sketch or Diagram of your system and/or problem, and an EFS representative will contact you.

Contact Information
EFS, LLC
11190 W Center Avenue
Lakewood, CO 80226

Phone: 303.478.7201

Email: info@efsfilter.com