FRED C. GILBERT ORDER FORM
FRED C. GILBERT CO.
 QUOTATION REQUEST

If you would like price & delivery information on a pump, parts or an accessory (valves, fittings, tanks etc.) you may fill out the following request form. Not all fields need to be filled in or checked - only those that apply. If you don't know exactly what you need please try to include as much pertinent information as possible with your request:

email:. . . . . . . . . . . . . .
Name: . . . . . . . . . . . . . .
Company: . . . . . . . . . . . . 
Address: . . . . . . . . . . . . 
City, State & Zip:. . . . . . . .
Telephone: . . . . . . . . . . . 
Fax:. . . . . . . . . . . . . . .
Part #:. . . . . . . . . . . . . 
Description:.  . . . . . . . . . 
Pump Model#:.  . . . . . . . . . 
Type of drive:
Air or Gas driven  Gasoline Engine  Beam Driven  Solar (DC)
Electric motor(please provide specs) . . .


Type of pump:
Metering (adjustable)  Transfer  


Type of control:
Manual  External signal  4 - 20 ma  Paced to flow  PH Control   

 

Volume to be pumped: . . . . . . 



Discharge pressure:. . . . . . . 



Type of chemical:. . . . . . . . 





Quantity:. . . . . . . . . . . . 



General requirements: . . . . . .


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