Date:
...

Company name

Adress

Telephone

Fax

Contact person

E-mail

Please, fill in the following information:

1) Production:

2) Liquid to be filtered:

3) Quantity l/min:

4) Solids in liquid mg/:

5) Original furnish mix:

6) pH:

7) Temperature ºC:

8) Application for filtrate:

9) Any polymer available:  Yes No

10) Any other comments or special requirements:

Please fill in and return or if you have any questions, please contact us.

ALGAS FTS AS, Strandgt.13-15, P.O. Box 534, 1503 Moss, Norway
Phone: + 47 69254034, Telefax: + 47 69250293, http://www.algas.no, e-mail: office@algas.no