*Company:
*Contact:
*Address:
*City:
*State:
*Zip:
* E-mail:
Phone:
Fax:
Mobile:
Well:
Location:
Field:
GPS:
Pumper:
County:
* Required fields
Conditions
Please fill in as much as possible.
Elevation:
Volume Per Day:
Suction Pressure:
Discharge Pressure:
BTU Content:
Specific Gravity:
Daily Fluid Production:
Water / Oil Ratio:
Production Zone:
Presence of H2S:
Yes
No
Presence of HEXANE +:
Yes
No
IF H2S OR HEXANE IS PRESENT A GAS ANALYSIS IS NEEDED
New Application:
Yes
No
Production History:
(in years)
Driver:
Yes
No
Bid Closing Date:
Unit Delivery Date:
Number of Units:
Options / Comments:
