Company Name:
Address:
City:
State/Province:
Zip/Postal Code:
Name of Contact:
Email:
Phone:
Project Name:
Project Location:
Building Type:
Home or Cottage
Residential Building (multi-unit)
Office or Multiuse Building
Dormitory
School or College
Hotel or Conference Centre
Arena or Recreation Centre
Hanger or Warehouse
Multi-Building Complex
Labour Camp or Mine
Theatre or Concert Hall
Other
If other, please describe:
Number of Floors: 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
Number of Apartments or Rooms:
Area of Building (square feet):
Number of Occupants:
Potable Water Source:
Public
Private
Sewage Disposal Source:
Public
Private
Power Availability:
Phase 1 (110/220, 50/60 Hz)
Phase 3 (230/280/460, 50/60 Hz)
Potential Sources
(check all that apply)
Greywater
Showers
Bath Tubs
Lavatories
Rain Water
Roof Drains
Ground Water
Well
Sump Pump
Ground Swale
Other
A/C Condensate
Reverse Osmosis Wastewater
Swimming Pool
Process Wastewater
Other Unlisted Sources
If applicable, how many washing machines:
Make:
Model:
If applicable, how many lavatories:
Number of Showers:
Number of Bathtubs:
Is Rainwater Harvesting Planned:
Yes
No
If yes, area of Roof (sq. ft.):
Any fixtures supplying Greywater on the Same level as the Brac System?:
Yes
No
If yes, how many and what type?:
Planned use for Reclaimed Water:
Toilet Flushing
Irrigation
Flushing & Irrigation
Equipment Washing
Other
Total number of toilets:
Number of Toilets per floor:
Type of Toilets:
Tank Type
Flush valve
If irrigation is planned, what area of space is to be watered?::
Estimated or target start date for the overall construction:
Estimated date shop drawings will be required:
Estimated date for tank installation :
Estimated date equipment will be required on site :
Estimated commissioning date:
How did you hear about Greyter?:
Security Code (making sure that you are a human): *
