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Mayo (IE)
Republic of Mordovia (RU)
Monseñor Nouel (DO)
Morelos (MX)
Moscow Oblast (RU)
Moscow (RU)
Monte Plata (DO)
Northern Mariana Islands (US)
Mpumalanga (ZA)
Madhya Pradesh (IN)
Mississippi (US)
Mato Grosso do Sul (BR)
Mureș (RO)
Massa-Carrara (IT)
Montana (US)
Matera (IT)
Matrouh (EG)
Mato Grosso (BR)
María Trinidad Sánchez (DO)
Murcia (ES)
Maluku Utara (ID)
Murmansk Oblast (RU)
Manawatu-Wanganui (NZ)
Mizoram (IN)
Misiones (AR)
Shetland Islands (GB)
Isle of Skye (GB)
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Napoli (IT)
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New Brunswick (CA)
North Carolina (US)
Northern Cape (ZA)
North Dakota (US)
Nebraska (US)
Novgorod Oblast (RU)
New Hampshire (US)
Noord-Holland (NL)
Nizhny Novgorod Oblast (RU)
New Jersey (US)
KwaZulu-Natal (ZA)
Newfoundland and Labrador (CA)
Nagaland (IN)
Nuevo León (MX)
New Mexico (US)
Novara (IT)
Oslo (NO)
Rogaland (NO)
Møre og Romsdal (NO)
Nordland (NO)
Svalbard (NO)
Jan Mayen (NO)
Viken (NO)
Innlandet (NO)
Vestfold og Telemark (NO)
Agder (NO)
Vestland (NO)
Trøndelag (NO)
Troms og Finnmark / Romsa ja Finnmárku (NO)
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Nelson (NZ)
Negeri Sembilan (MY)
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Neamț (RO)
Northern Territory (AU)
Nusa Tenggara Timur (ID)
Northwest Territories (CA)
Northland (NZ)
Nunavut (CA)
Nuoro (IT)
Nevada (US)
Novosibirsk Oblast (RU)
North West (ZA)
New York (US)
Asturias (ES)
Isles of Scilly (GB)
Kent (GB)
Kincardineshire (GB)
Kinross-Shire (GB)
Oaxaca (MX)
Ogliastra (IT)
Ohio (US)
Oklahoma (US)
Omsk Oblast (RU)
Ontario (CA)
Ourense (Orense) (ES)
Oromia (ET)
Orissa (IN)
Oregon (US)
Oristano (IT)
Orenburg Oblast (RU)
Oryol Oblast (RU)
Olbia-Tempio (IT)
Olt (RO)
Otago (NZ)
Overijssel (NL)
Offaly (IE)
Formosa (AR)
Palencia (ES)
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Lanarkshire (GB)
Lancashire (GB)
Leicestershire (GB)
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Papua (ID)
Pennsylvania (US)
Pará (BR)
Palermo (IT)
Punjab (IN)
Paraíba (BR)
Papua Barat (ID)
Piacenza (IT)
Padova (IT)
Prince Edward Island (CA)
Pescara (IT)
Pernambuco (BR)
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Peravia (DO)
Perm Krai (RU)
Petén (GT)
Perugia (IT)
Prahova (RO)
Pahang (MY)
Piauí (BR)
Pisa (IT)
Putrajaya (MY)
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Pordenone (IT)
Pulau Pinang (MY)
Penza Oblast (RU)
Pontevedra (ES)
Prato (IT)
Puerto Plata (DO)
Papua Pegunungan (ID)
Paraná (BR)
Parma (IT)
Puerto Rico (US)
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Pskov Oblast (RU)
Pistoia (IT)
Papua Tengah (ID)
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Puebla (MX)
Putumayo (CO)
Pavia (IT)
Palau (US)
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Rimini (IT)
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Rondônia (BR)
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Quintana Roo (MX)
Rostov Oblast (RU)
Roraima (BR)
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Ryazan Oblast (RU)
Cantabria (ES)
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Stockholms län (SE)
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Norrbottens län (SE)
Uppsala län (SE)
Södermanlands län (SE)
Östergötlands län (SE)
Jönköpings län (SE)
Kronobergs län (SE)
Kalmar län (SE)
Gotlands län (SE)
Blekinge län (SE)
Skåne län (SE)
Hallands län (SE)
Västra Götalands län (SE)
Värmlands län (SE)
Örebro län (SE)
Västmanlands län (SE)
Dalarnas län (SE)
Gävleborgs län (SE)
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Jämtlands län (SE)
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Saskatchewan (CA)
Sikkim (IN)
San Luis Potosí (MX)
Satu Mare (RO)
Somalia (ET)
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Smolensk Oblast (RU)
Sulawesi Selatan (ID)
Soria (ES)
Sondrio (IT)
Sligo (IE)
Sololá (GT)
Sonora (MX)
La Spezia (IT)
Southern Peoples, Nations, and Nationalities (ET)
São Paulo (BR)
Saint Petersburg (RU)
San Pedro de Macorís (DO)
Siracusa (IT)
Sulawesi Barat (ID)
Sánchez Ramírez (DO)
Santa Rosa (GT)
Santiago Rodríguez (DO)
Gipuzkoa (Guipúzcoa) (ES)
Sumatra Selatan (ID)
Sassari (IT)
Sulawesi Tengah (ID)
Stavropol Krai (RU)
Santiago (DO)
Southland (NZ)
Sud Sardegna (IT)
Sumatra Utara (ID)
6th of October (EG)
Sucre (CO)
Suchitepéquez (GT)
Suez (EG)
Savona (IT)
Suceava (RO)
Sverdlovsk Oblast (RU)
Sarawak (MY)
Tucumán (AR)
Tarragona (ES)
Perthshire (GB)
Powys (GB)
Renfrewshire (GB)
Ross-Shire (GB)
Roxburghshire (GB)
Taranto (IT)
Republic of Tatarstan (RU)
Tabasco (MX)
Tamaulipas (MX)
Tambov Oblast (RU)
Tasman (NZ)
Tasmania (AU)
Teruel (ES)
Teramo (IT)
Tyrone (IE)
Santa Cruz de Tenerife (ES)
Tigray (ET)
Taranaki (NZ)
Tulcea (RO)
Tlaxcala (MX)
Timiș (RO)
Tamil Nadu (IN)
Tennessee (US)
Trento (IT)
Tocantins (BR)
Toledo (ES)
Torino (IT)
Tolima (CO)
Tomsk Oblast (RU)
Totonicapán (GT)
Trapani (IT)
Teleorman (RO)
Terni (IT)
Tipperary (IE)
Tripura (IN)
Terengganu (MY)
Telangana (IN)
Trieste (IT)
Tula Oblast (RU)
Treviso (IT)
Tver Oblast (RU)
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Tyva Republic (RU)
Tyumen Oblast (RU)
Chubut (AR)
Selkirkshire (GB)
Shropshire (GB)
Somerset (GB)
South Glamorgan (GB)
Udine (IT)
Udmurtia (RU)
Uttarakhand (IN)
Ulyanovsk Oblast (RU)
Uttar Pradesh (IN)
Umm al-Quwain (AE)
Utah (US)
Utrecht (NL)
València (Valencia) (ES)
Tierra del Fuego (AR)
South Humberside (GB)
South Yorkshire (GB)
Staffordshire (GB)
Stirlingshire (GB)
Suffolk (GB)
Varese (IT)
Valladolid (ES)
Virginia (US)
Valle del Cauca (CO)
Valverde (DO)
Vaupés (CO)
Verbano-Cusio-Ossola (IT)
Vercelli (IT)
Venezia (IT)
Veracruz (MX)
Volgograd Oblast (RU)
Araba/Álava (ES)
Virgin Islands (US)
Vicenza (IT)
Victoria (AU)
Vichada (CO)
Vâlcea (RO)
Vladimir Oblast (RU)
Vologda Oblast (RU)
Vrancea (RO)
Lai Châu (VN)
Lào Cai (VN)
Hà Giang (VN)
Cao Bằng (VN)
Sơn La (VN)
Yên Bái (VN)
Tuyên Quang (VN)
Lạng Sơn (VN)
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Hòa Bình (VN)
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Nghệ An (VN)
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Thừa Thiên - Huế (VN)
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Bình Định (VN)
Phú Yên (VN)
Đắk Lắk (VN)
Khánh Hòa (VN)
Lâm Đồng (VN)
Ninh Thuận (VN)
Tây Ninh (VN)
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Long An (VN)
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Bạc Liêu (VN)
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Điện Biên (VN)
Đắk Nông (VN)
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TP Cần Thơ (VN)
TP Đà Nẵng (VN)
Hà Nội (VN)
TP Hải Phòng (VN)
TP Hồ Chí Minh (VN)
Voronezh Oblast (RU)
Verona (IT)
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Medio Campidano (IT)
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Viterbo (IT)
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West Yorkshire (GB)
Wigtownshire (GB)
Jujuy (AR)
Wiltshire (GB)
Worcestershire (GB)
Yamalo-Nenets Autonomous Okrug (RU)
Yaroslavl Oblast (RU)
Jewish Autonomous Oblast (RU)
Yogyakarta (ID)
Yukon (CA)
Yucatán (MX)
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北京市 (CN)
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宁夏回族自治区 (CN)
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广西壮族自治区 (CN)
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海南省 (CN)
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内蒙古自治区 (CN)
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贵州省 (CN)
Zip
*
Contact Name
*
Job Position
Phone Number
*
Contact Email
*
Email cc
Separate email addresses with a comma.
Subject
*
What is the issue? / What are we doing here?
Expected Closing
Expected Revenue
Referred By
A: Water Used For
*
School
Restaurant
Hotel / Motel
Multi Family / Apartment Building
Nursing Home / Hospital
RO
Boiler
Laundry
Dishwasher
Other
If checking off multiple boxes, make sure to input the info for both boxes.
# Of People
*
# Of Seats
*
# Of Rooms
*
# Of Rooms...
*
# Of rooms, how many bathrooms per room, average amount of residents per room, average patients at once
# Of Apartments...
*
# Of apartments, how many bathrooms per apartment, average amount of residents per apartment
Flow Feed Rate
Horsepower (HP)
Horsepower (HP): (specify how many boilers as well)
# Of Machines
What size machines, and how many machines
# Of Machines
What size machines, and how many machines
Specify application and relevant info
What size machines, and how many machines
B1. Hours Per Day Operation:
B2. Days Per Week:
C. Water Requirements
Check box if all relevant info in this section is entered
Constant Flow Rate: (GPM)
Peak Flow (GPM)
Daily Usage / 24 Hours:
Days Per Week
Hot
Cold
Both
Water Usage Determined By:
D: Water Quality Required
Check box if all relevant info in this section is entered
Permissible Hardness Leakage (ppm):
E1. Water, Influent
Check box if all relevant info in this section is entered
Source:
Municipal
Private Well
Surface
Flow Rate
*
Flow Rate
*
E2. Composition
Check box if all relevant info in this section is entered
Total Hardness (GPG)
Color
TDS
Manganese
Turbidity
Tannin
Iron (Total)
Iron (Ferrous)
Iron (Ferric)
H2S
How strong is the smell?
pH
Odor
Other
F. Facilities
Check box if all relevant info in this section is entered
Supply Pipe Size (in)
*
Pump Capacity (gpm)
Drain Line Capacity
Existing Storage Tank
Specify dimensions and gallonage
Operating Pressure (psi)
Pressure At Point Of Install (psi)
Drain Location
Other
G. Installation Details Or Limitations
Check box if all relevant info in this section is entered
Available Floor Space
Specify in inches "Length x Width x Hight" (Upload a sketch with objects in the area and where you are measuring)
Upload Sketch
Door Openings
Need to make sure we can bring equipment into this room from outside.
Stairways or Elevator
Specify accessibility
Drain Location
Any Other Unusual Installation Requirements
H. Existing Equipment At This Site
Yes
No
Specify What Is On Site
Notes/Special Requirements
Main Attachment
Responsible User
Shmuel Shifrin
Yosef Belkin
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