Product Request Form  -   Fields marked with an * are required.

First Name*    Middle Initial      Last Name* 
Street Address*
City*    State/Province* 
Country     Zip/Postal Code* 
Telephone Number  -   -     Email*  
What is it?*
(as detailed as possible, include a sketch or diagram)
Where does it apply?*
(where in your system or company will it be used, such as distribution piping, maintenance, treatment plant, etc.)
(who will use this item or who will approve its purchase)
Why is it worth exploring?*
(potential for cost/time savings, efficiency improvements, better safety, easier maintenance, nothing similar available, current items inferior, etc.)
What is the estimated annual usage?*
When will it be needed?*
Sources for more information...

Mueller Company Water Products Division Return completed form by mail or fax to:
Mueller Company
500 W. Eldorado St.
PO Box 671
Decatur IL 62522
FAX: (217) 425-7537