* = must be filled out

Contact Information
Name*
Position*
Company*
ZIP
City*
Country*
Phone*
Email*

Water Requirements and Well Situation
Daily Requirements*		l/day m³/day US-Gal./day Imp. Gal./day
Seasonal Variations in Water Requirement*
Total Vertical Lift*		m ft
Depth of Well		m ft
Static Water Level		m ft
Recovery Rate		l/h m³/h US-Gal./h Imp. Gal./h
Length of Pipe		m ft
Water Temperature of Well*	10-20°C / 50-68°F (most common) 20-30°C / 68-86°F 30-40°C / 86-100°F above 40°C / 100°F
Water Quality*
Storage Tank Available?	yes no

Location of Installation
System Location*
Country*
Longitude		W O
Latitude		N S

Solar Installation
Length of Cable		m ft
Power Supply	PV-direct battery

Misc.
Other Remarks

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