SELECTIVE ADSORBENTS ASSOCIATES, INC

Application Request Form

Thank you for your interest in our products and services. If you cannot call us to discuss your needs right now, please take a minute to supply the Application information below. We will do an application estimate and will contact you to discuss potential solutions.


Your name:
Position:
Company Name:
Street Address:
City, State, Zip Code:
Your email address:
Telephone Number:		Fax:
INDUSTRY (check all that apply)
Chemicals	Type:
Clean Room
Electronic/Chip
Fiber/Fabric Mfr.
Fluorescent Lamp Mfr.
Metal Treating
Recycling	Type:
Tape Mfr.
Water Treatment
Sewerage
Other	Type:
GOAL (check all that apply)				CONDITIONS
Meet Emission Limit				Temp.,Deg.F:
Odor Control				Pressure, psig:
Process Step Impurity				Viscosity, cP:
Product Purity				Flow Rate:
Protect Equipment				Flow Rate Unit:
Protect Enclosed Space
Safety
CONTAMINANT COMPOUND			*EXISTING CONC.			*DESIRED CONC.



*UNITS OF CONCENTRATION FOR ABOVE CONTAMINANTS:

BULK FLUID	MAIN COMPONENTS				PERCENTAGE		WT/VOL
Air Gas Liquid Water					%		Percentages are of:
					%
					%
					%
What is Upstream?
What is Downstream?
Have you considered or tried other means to reach this goal? If so, what?
TIMING FOR ACTION

Immediate need
Project yet to be budgeted, estimate needed for planning
Deadline is
Expected Project Implementation Date

Selective Adsorption Associates, Inc. 534 Gables Court Langhorne, PA 19047 USA
Telephone: (215) 702-0323 FAX: (215) 702-0577 Email: saai@selectiveadsorption.com

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