(*required fields)
Customer Information:
Company Name:*
Phone Number:*

Fax Number:
E-mail Address:*

Process Data:
Fluid*    pH  Concentration %
Viscosity*      CP, CKS, Other Specify
Specific Gravity*   Density lb/ft3 kg/m3
Process Service: hours/day days/week weeks/year
Flow Rate* GPM Operating Pressure* psig Max Differential Dirty  psid
Max Differential Clean psid Max Differential Dirty psid
Description of Contaminate*   Particle Size Distribution
Total Solids (ppm) Micron Rating* Removal Efficiency*   Bata Ratio
Is fluid currently being filtered? Yes No If yes, what type of filter
Part Number of Current Filter
Problems incurring with current filtration:
Specify Media Choice: Core:
Please fill this application out to the best of your knowledge. The more information we
have about a particular application, the more exact we can be meeting your filtration specifications.
Incorrect data may result in compatibility and sizing problems.
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