SIMS PUMP VALVE CO., INC.

ORDER FORM

Order Form

CUSTOMER :
NAME :
TELEPHONE # :
FAX # :
EMAIL:
DATE :
ADDRESS :
Check Required Items:
Impellers
Casing Rings
Wear Rings
Sleeves
Guide Bearings
Shaft
Complete Pump
Other Items
PUMP MANUFACTURER :
MODEL NUMBER :
SERIAL # or NSN # :
PUMP TYPE & SIZE :
PUMP SERVICE :
IMPELLER DIAMETER
IMPELLER OVERALL WIDTH (HEIGHT) :
Check One:
Single Suction
Double Suction

Pump Performance :
CAPACITY
NPSHA
TOTAL HEAD
RPM
BHP
For Vertical Pumps:
Pit Depth
Pit Width
Length of Pump
Distance from Top Plate to Water Level

Reason for Replacement :

1- CORROSION.
If other than SALT WATER
LIQUID PUMPED% Temperature

2 - EROSION.
If other than SALT WATER
LIQUID PUMPED% Solids

3- CAVITATION.
4- DROP IN PERFORMANCE.
5- EXCESSIVE VIBRATION.
6- SEIZED.
7- MECHANICAL FAILURE.
8- OTHER

EXPLAIN: