CONTACT US

	This form may be directly filled in on your monitor and emailed to us, or print it out, fill it in, and fax it to (201) 750-1096. TWT is happy to provide an on-line quote and information request form to make your evaluation and purchase process as streamlined as possible. Your completed system quote and/or additional information will be provided to you by either TWT or an authorized TWT dealer or distributor, via e-mail (or fax, if requested). Please feel free to call us with any questions. Please provide the following information so that our technical staff may evaluate your fluid management requirements and make proper recommendations. The information provided should as complete as possible, since water conditioning programs can vary depending on the chemical characteristics of the water, season of the year, and geographical location.



	First Name: Last Name: Title: Company name: Company mailing address: City: State: Country: ZIP Code: Telephone: Fax: E-Mail address: Please use the space below to describe the equipment and conditions that now exist and/or specific improvements that are being sought. If faxing the form, please use additional sheets as necessary. Geographic area? What is the environment of the water treatment problem? Residential Commercial Industrial Mobile Other environment: What water treatment problems do you have? Scale Corrosion Algae Bacteria Mold/Fungus Other problem: What type of scale deposit do you have? Calcium Iron Manganese Silica Boron Chlorides Other scale problems: If fluid testing has been completed, please indicate the test results, or fax the test results to (201) 750-1096 Attn: Web Quote. How long has there been a deposit problem, and to what degree (e.g., % of blockage, etc.)? Source of water (well, municipal, pond, river, treatment plant, etc.): Flow rate (gallons per minute, liters per minute, etc.): Water quality (Total Dissolved Solids): Water quality (Grains per gallon): Water quality (Conductivity): What is your application? Cooling Tower Evaporative Condenser Chilled Water Loop Hot Water Loop Boiler Evaporative Cooler Water Cooled Air Compressor Water Cooled Vacuum Pump Ice Machine Swimming Pool Spa Domestic / Potable Water Non-Potable Water Irrigation Waste Water Treatment Decorative Water Fountain Dish Washer Food Steamer Hot Water Heater Commercial Laundry Dry Cleaning Machines Clothing Pressing Machine Printing Press Pumps Engines Other application: For hot water boiler application, please provide operating temperatures: What is the pipe material and size of pipe in the system for which you want treatment? What end result do you require? Remove existing scale Improve energy efficiency Extend equipment life Save labor costs Prevent new scale build up Eliminate bacteria Eliminate algae Other result: What TWT products are you interested in? Commercial / Industrial Deposit Control Systems Reaction Chambers Bypass Systems Industry-Specific Integrated Systems Ultraviolet Disinfection Systems IonGuard Purification Systems Dental Disinfection System Total Water Control System Emergency Water Supply System NutraChem Photo Chemical Disposal System Residential / Light Commercial Deposit Control Systems Counter Top Water Filter Under Counter Water Filter Systems Bottleless Water Cooler Showerhead Water Filter Whole House Water Filter Residential Ultraviolet Disinfection Systems Residential IonGuard Pool / Spa System Replacement Filter Cartridges What current treatment and/or products or systems do you now use to deal with this problem (e.g. softener, chemicals, filters, etc.) What electrical voltage is available at the installation site? 110 v 220 v Other voltage: What do you currently spend on chemicals and/or other treatments? How much time is spent attending to or supervising the operation of the current system? What do you currently spend on water and sewer per 1000 gallons? What do you currently spend on water and sewer per year? What do you currently spend on maintenance of the system per year? Is your current water treatment budget fully funded, and is there an established ceiling? Please add any additional information you think may be appropriate. Thank you, we will be in contact with you soon. Triangular Wave Technologies, Inc. 272 Closter Dock Road, Suites 4, 5, 6 Closter, NJ 07624 U.S. Toll-Free Telephone: (800) 728-3420 Telephone: (201) 750-1063 Fax: (201) 750-1096