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Custom Engineer Your System

Please complete the following form and submit with your request for a system quotation, or download and complete our system questionnaire and fax it back to R.O. UltraTec at (760) 728-5062.

Contact Info
Company Name:
*First Name:
*Last Name:
*Title
*Phone:
Fax:
Cell Phone:
*Email:
Website:

Billing Address
*Billing Address:
*City:
*State:
*Zip Code:
*Country:

Shipping Address ( Same and billing address)
Shipping Address:
City:
State:
Zip Code:
Country:

Project Information
Project Status:
Require Quotation By:
Do you have experience in ordering or installing commercial water treatment equipment?	Yes No

Application

Application:

If you know your specific requirements, please specify Permeate (product water) volume and quantity required:

U.S. Gallons per Day US GPD

Metric Liters per Day LPD

Metric Tons per Day M3/Day

What will the product water be used for?

Drinking

Bottling

Medical

Pharmaceutical

Car Wash

Restaurant

Water Store

Other:

Operation:

Hours per Day

Days per Week

Weeks per Year

Do you anticipate an increase in
demand in the next 5 years?

Yes No

If yes, by how much?

What is the current storage capacity?

Gallons/Liters

Do you plan to increase the storage capacity?

Yes No

Is there an existing pressurized feed water line to the system?

Yes No

If yes, pressure available:

PSI

KPA

Weeks per Year

Space limitations for systems:

Length (inches)

Width (inches)

Height (inches)

Required Equipment

What will the product water be used for?

Water Filtration

Water Softeners

Reverse Osmosis

Chemical Treatment

Ozonation

Ultraviolet

DI / EDI

Other:

Product Water repressurization required?:

Yes No N/A

Do you require post treatment?

Yes No N/A

Available Power?

Feed Water Type

Source:

Well Water

Municipal/City Water

Surface Water (River/Lake)

Brackish Water

Sea Water

Other:

Is there a history of seasonal fluctuations in the water source or water quality?:

Yes No

Is there Chlorine present in the feed water supply?

Yes No

If yes, what is the concentration?

mg/l

Feed Water Analysis

Note: A complete water analysis must be provided before any system is custom designed and/or manufactured.

Feed Water Temperature Range:

Low: °F High: °F

Low: °C High: °C

Total Dissolved Solids (TDS):

MG/L PPM Micro Siemens

Amount:

Total Hardness:

pH:

Magnesium (Mg++):

Manganese (Mn++):

Total Iron (Fe):

Portion AS Fe+++:

Silica (SiO2):

Conductivity:

Turbidity:

Calcium (Ca++):

Fluoride (F-):

Portion AS Fe++:

Alkalinity (CaCO3):

Suspended Solids:

Micromhos/Cm Color Units:

Ammonium (NH4):

Barium (Ba):

Bicarbonate (HC03):

Boron (B):

Carbonate (C03):

Chloride (CL):

Nitrate (N03):

Potassium (K):

Sodium (Na):

Strontium (Sr):

Sulfate (S04):

Other:

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