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1801 Falls Ave. Waterloo, IA 50701
319-233-6101
Home
About
Safety
Services
Boiler Systems
Gas Fired Equipment
Certified Welding Services
Process Piping
Pump Services
Certified Backflow Testing
Inspections
Parts
Careers
Contact
Parts Only
Parts Only
Use this form for parts only not related to a job.
Step
1
of
10
10%
Employee Name
(Required)
Customer
(Required)
Job Location
(Required)
Contact Name
(Required)
Contact Phone
(Required)
Description of Parts Needed
(Required)
Equipment Information
Equipment Manufacturer
Equipment Model Number
Equipment Serial Number
Upload Photos
Please provide photos and comments as needed to help identify system and parts.
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Select files
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Picture Comments
Operating System
System Type
Select One
Steam
Hot Water
Air
Gas
Oil
Other - See Notes
Pressure Unit
Select One
PSI
inches
CFM
Gallons
Other - See Notes
Maximum System Pressure
Operating Pressure
Operating Pressure
Relief Valve - MFG
Relief Valve - Model #
Relief Valve - Inlet Size
Relief Valve - Outlet Size
Relief Valve - Units
Select One
lbs/hr
BTU/hr
SCFM
gallons/min
Other - See Notes
Operating System Notes
Retube Information
Pass
Select One
1
2
3
4
Tube Count
Tube Length (in inches) - Bead to Bead + 2"
Tube Diameter (in inches)
Pass
Select One
1
2
3
4
Tube Count
Tube Length (in inches) - Bead to Bead + 2"
Tube Diameter (in inches)
Retube Notes
Motor Information
Motor Manufacturer
Motor Serial Number
Motor Model Number
Voltage
Select One
24
110
208
220
240
Other - See Notes
Phase
Select One
1
3
Horsepower
Select One
1/16
1/4
1/3
1/2
1
1.5
2
3
4
Other - See Notes
RPM
Select One
1724
3450
Other - See Notes
Frame
Motor Notes
Pump Information
Pump Manufacturer
Pump Model Number
Pump Serial Number
GPM
Pump PO #
Feet of Head (PSI)
Pump Inlet Size (inches)
Pump Discharge Size (inches)
System Pipe Size (inches)
Pump Notes
Motor Stater Information
Incoming Voltage
Motor Starter Coil Voltage
Contractor Manufacturer
Contractor Model Number
Overload Manufactuer
Overload Model Number
Current Overload Rating/Setting
Current Overload Range
Any additional information needed?
(Required)
Section Break
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