Product Info/ Dealer Referral Request

    Your answers to the questions below will help us guide you in selecting the product that best suits your needs. We thank you in advance for answering the following questions.

    1. Is your main interest in sediment-free water collection?

    2. What kind of pressure is your pump (discharge) considered?

    3. List pump details (make, model, intake/outlet dimensions, etc.)

    4. What is the in-flow connector type (including thread description, if applicable)?

    5. What are the volume flow requirements (in gallons/liters per minute)?

    6. Describe your intended use of the product and any additional information that would be useful in helping serve you better.

    7. Please attach photos, if available.

    If you already know which Ceptor you need, please provide the make and model of the pump in #5 above, and then complete the billing information below.

    Contact Name*
    Phone Number*
    Email*

    Company Name (legal and operating)
    Attention

    Billing Address

    How did you hear about BearsPaw Separators?

    Comments/instructions/details of products required