Your Full Name:

Your Title:

Company Address:

City:

Country

E-mail:

Telephone:

Mobile or Direct :

Fax:

Information on Your Water System(s), Network(s) or Tank(s)
(Please answer all applicable fields)

Type of Water:

Total water volumes
to be treated

Number of domestic hot water loops:

Approximate
Domestic Hot Water
usage per day
(M3PD or GPD)

Number of patient beds per Domestic Hot Water loop

Please describe the location where the water network(s) is (are) located.

Average Water TDS:
(Total Dissolved Solids)

Average Water pH:

Calcium Hardness:

Average Incoming Domestic Water Temperature: