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Name:
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Mailing address
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City, State, Zip
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Phone
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Email Address:
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Describe the pump's water source (river, pond, cistern, well)
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Nearest zipcode or city for pump system's location
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If not in U.S., what country?
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What is the water to be used for? (agriculture, livestock, household....)
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Gallons per day of water required
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Do you need more water in summer or winter? Describe seasonal variation in water requirements.
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Is there a pump already in place?
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Yes
No
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If yes, please describe.
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Describe your on-site storage (water tank, pressure tank, cistern, none).
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Does your pump need to run at night?
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No (PV direct; no batteries)
Yes (will need batteries)
Other
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If "other", please describe.
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Does the pump also need to run on AC power (generators orutility power)?
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Yes
No
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If you have a well, describe your well and borehold. Well depth in feet:
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Well static water level
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Well casing's inside diameter in inches
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If you need a surface pump, what is the suction lift (or vertical distance from water level to inlet of pump) in feet
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Water source recovery rate
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Vertical lift in feet from ground level to point of storage or delivery
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Horizontal distance from the water source to the point of storage or delivery, in feet
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Pipe diameter in inches if horizontal distance is greater than zero.
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Type of pipe, if horizontal distance is greater than zero.
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Does the water need to be pressurized?
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Yes
No
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If so, what is the Pounds per Square Inch (PSI)? (40 PSI is typical city water pressure.)
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What is the budget of your pump project?
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