Request service information

Contact information

Client/Company name *

Contact name *

Title

Phone number *

Email address *

Billing address *

Mailing address (if different from billing address)

Sales person (enter name of representative or N/A if you don’t deal with a PWT rep) *

Select desired service *

Type of system (ex: UF, MBR, RO) *

Capacity *

Reason for work request *

Manufacturer *

Model *

Element location in system *

Element age *

Any current damages to exterior of the membrane? *
YesNo

System configuration *

System product water flow rate - designed (gpm, m3/d, MGD) *

System product water flow rate – actual (gpm, m3/d, MGD) *

Feed conductivity *

Permeate conductivity *

Differential pressure – design *

Differential pressure – actual *

Feed pressure – design *

Feed pressure – actual *