Name : ______________________________________      Date: ________________________
Address: ____________________________________      Taken In By: ___________________
City: __________________________ Zip: _________

Subdivision   ________________________________ Contractor   __________________

Daytime Phone _____________________________  Phone   ______________________               

WATER SOURCE

Irrigation Water:

______ Pressurized:     PSI ______________________         GPM  _____________________________

______       NON-pressurized:         WHICH TYPE:  POND  CISTERN  SUMP  PIPE  DITCH

                  Amount of water entitled to? __________________________________________________

                         Pump Limitation __________________            Size of storage/pipe ________________

        _____ Need Pump

        _____ Have Pump  HP ________ Inlet ________ Outlet ________ Model ________________

Domestic Water: Provider _________________________________________________________________

                          Static PSI   _________________________                Dynamic PSI  ______________________

AUTOMATIC                             or MANUAL                                        or QUOTE BOTH_______________

SPECIFIC REQUESTS/REQUIREMENTS _________________________________________________________

_________________________________________________________________________________________