BOBRUISK MACHINE BUILDING PLANT

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Dear Sirs!

If you are interested in purchases of our products you should remember that to choose a

type of pump you need, valuate its price, delivery time and other details we require

additional information. So we ask you to answer the following questions.

ORDER FORM

TO THE COMMERCIAL

MANAGER

Dear______________________, we ask you to investigate the possibility

of deliverying your products on the base of the following requests:

1. Transfered medium _________________________________________________

1.1. Temperature _____________________________________________________

1.2. Viscosity (density) _________________________________________________

1.3. Mechanical impurities (size, мм) ______________________________________

1.4. Reactivity________________________________________________________

2. Volume of transfered liquid, m.кub/h ____________________________________

3. Required head, m ___________________________________________________

4. Type of compaction_________________________________________________

5. Material of flow part ________________________________________________

6. Diameter of inlet and outlet pipe ________________________________________

7. Overall sizes_______________________________________________________

8. Engine___________________________________________________________

8.1.Version (explosion-proof /ordinar)_____________________________________

8.2. Capacity________________________________________________________

8.3. Rotary speed_____________________________________________________

8.4. Voltage_________________________________________________________

8.5. Frequency_______________________________________________________

9. Amount_________________________________________________________

10. Prospective or alike produced brand____________________________________

11. Others' ___________________________________________________

Our organization:____________________________________________

___________________________________________________________

Address: srteet____________________ city_______________________

index_____________ country____________________________

Phone______________ fax_____________ city code_______________

E-mail_____________________________________________________

http:// _____________________________________________________

Name_________________________ Surname _____________________

Post_________________ Signature______________________

Recommendation: get the entire document, re-copy on your hard disk (save as), edit

(delete uninformation part and fill up the form), print and send it by

fax + 375 (2251) 73-619

Attention: mention, please, we don't render a service which is not

connected with our work.