Gusher Pumps

All of our pumps are manufactured using a unique "Z-CODE" to insure the correct configuration of components and options to meet the specific needs of the pump.

Please provide the following contact information:

Name

Organization

Street address

Address (cont.)

City

State/Province

Zip/Postal code

Country

Phone

FAX

E-mail

Please provide the following ordering information:

(Please include all vital information such as hp, rpm, phase, "z-code",
or serial number of existing pump)

Quantity	Description

Billing Information

Purchase order #
Account Number

Shipping Information

If same as above you may enter "SAME" in ship to field.

Ship to

Street address

Address (cont.)

City

State/Province

Zip/Postal code

Country

Tagging

Ship Via

Note: If not marked 3rd.party, it will be shipped collect. Cannot ship pre-paid.

Expected Delivery Date

- mm/dd/yy

Additional Information