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Sample Filter Bag Request

Email Inquiry


Please complete the following form as completely as possible.  Optionally you may fax the information requested to our office at 908.362.5631 or call us and provide it verbally at 908.362.9981 between the hours of 8:30am to 5pm EST M-F.

Click Here for the PDF Version that you can complete and email or fax. SCROLL BELOW TO FILL-OUT THE FORM ONLINE.

All highlighted fields must be filled in to submit the form.

SECTION 1: CONTACT INFORMATION

Company :
Contact:
Address:
City:

State:

Zip:

Email Address:
Telephone#:
Fax#:

SECTION 2: APPLICATION DATA

What is your primary business?

What type of service is in need of filtration (cooling water, ink, paint, etc...?

What type of filtration is currently being used (bag, cartridge, etc...?

What exactly is the problem that you want to solve?

Brand or type of filter vessel to be used?

What brand or type of filter bag has been previously used?

Is this a continuous or batch duty application?

Flow rate:  

Operating pressure:
Operating Temperature:

SECTION 3:

Description of sample requiredMonthly Potential if Tests are Favorable Quantity Required for testing
Application Overview and Special Considerations: (noting any limitations, constraints or requirements)
 

This Equipment is Required Within: 

ACCEPTANCE NOTICE: The data submitted via this form is correct to the best of our knowledge.  However, we do not assume any liability for the accuracy of completeness of this data.  The final determination of suitability of product and information, use intended, manners of that use, or infringement of patents, is the responsibility of the user.

(Please indicate Agreement)
I agree     

 
FACTORY DIRECT PIPELINE PRODUCTS, INC.
Your Single Source for Industrial Filtration and Valve Products

Copyright 2001-2008
phone: 908.362.9981 x-302

Accept Credit Cards Online

fax: 908.362.5631
email: fdpp@fdpp.com