Company Name *
Contact Person Name *
Email Address *
Mobile *
Address *
City *
Total Roof Area (Sq.ft.)
No. of Roofs
Type of Roof
FlatSlope
No. of downtake pipes
—Please choose an option—12345678910 and above
Diameter of downtake pipes
—Please choose an option—3 inch4 inch5 inch6 inch7 inch8 inch
Detail of existing borewell/tube well
YesNo
Distance from downtake pipe —Please choose an option—Up to 5ft5ft - 10ft10ft - 15ft15ft - 20ft20ft - 25ft25ft - 30ft
Diameter —Please choose an option—3 inch4 inch5 inch6 inch7 inch8 inch
Depth —Please choose an option—100 ft.150 ft.200 ft.250 ft.300 ft.350 ft.400 ft.450 ft.500 ft.500 ft. and above
Submersible pump / HP —Please choose an option—1 HP2 HP3 HP4 HP5 HP
Water level —Please choose an option—100 ft.150 ft.200 ft.250 ft.300 ft.350 ft.400 ft.450 ft.500 ft.500 ft. and above
Water quality of existing well
Detail of existing tank
Tank Type —Please choose an option—OverheadOvergroundUnderground
Tank Capacity (Ltr.)
Remarks
Please upload site photographs (jpg or png only)
Attach Site Layout Plan (pdf file only)
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