Request A Quote:
Client Contact Information:
Client Industry:
Please Select an Industry
Pharmaceutical
Cosmetics
Commercial
Hospital
Biotechnology
Food & Beverage
Laboratory
Dialysis
Medical Device Mfg.
Industrial
Other
Company Name:
First Name:
Last Name:
Address 1:
Address 2:
City:
State/Province:
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Postal Code:
Phone:
e-Mail:
Preferred Contact:
Phone
e-Mail
Desired Final Product Water Specification:
Industrial/Commercial
Boiler Feed
Cooling Tower
RO Product Water
Laboratory Grade
CLSI
ASTM I
ASTM II
ASTM III
ASTM IV
Type A
Type B
Type C
Food & Beverage
Drinking Water (IBWA)
Spring Water (IBWA)
Purified Water
Biopharm
(Current) USP Purified
Conductivity Stage:
Stage 1
Stage 2
Stage 3
Water for Injection
Dialysis
AAMI Standard
Additional Purity Requirements:
μS/cm
MΩ-cm
Bacteria Specification (cfu/ml)
Total Organic Carbon (TOC) (ppb)
Endotoxin Specification (EU/ml)
Particles: Type
Particles: Limit
Other
e.g.: pseudomonas free, RNA/DNA free, etc.) please list here.
Will the water purification system be validated?
Yes
No
Water Usage:
How much water will be used in an eight-hour shift?
How many shifts per day?
How many shifts per week?
If there were to be an interruption in make-up water (city feed issue or pre-treatment service) how much reserve water for production would the Client like?
What is the Peak Instantaneous Demand?
How long does the Peak Instantaneous Demand last?
Form Verification:
What is the last letter in the English Alphabet?
TOTAL WATER provides service to Wisconsin, Minnesota, Illinois and Iowa
800-929-2236
::
608-221-2236
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highpuritywater@total-water.com