Name:

Email Address:

Ship to ZIP code

Project Zip if Different

Telephone

Purpose:
Livestock Watering
Pond
Backup to AC Pump
Irrigation
Residential
Other ​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​

Pumping From (water source):
Well
Cistern/Tank
Pond
Stream
Other ​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​

Water Needed Per day (gallons):
<500
1000
2000
5000
>5000

Pumping To (final destination):
Cistern/Tank
Pressure Tank
Other ​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​

For Well Pumping:
Well Depth: ​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​
Static Water Level: ​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​
Recharge Rate: ​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​
Diameter of Well Casing: ​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​
Desired Flow Rate: ​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​
Additional Vertical Lift From Well Head to Final Destination Point: ​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​

Option to switch over to AC Power (pump water with generator as needed):
Yes
No

Please choose one:
Pole Mount for the Solar Panels
Roof Mount for the Solar Panels

For Roof Mounted panels, please indicate roof material:
Metal
Composite

Do you have a Preferred Make/Model of Pump? ​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​

When Do You Plan to Purchase?
ASAP
A Few Months
Next Year (12 Months)
Just Researching

Comments:

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