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
12345678910 and above
Diameter of downtake pipes
3 inch4 inch5 inch6 inch7 inch8 inch
Detail of existing borewell/tube well
YesNo
Distance from downtake pipe
5ft - 10ft10ft - 15ft15ft - 20ft20ft - 25ft25ft - 30ft
Diameter
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
Water quality of existing well
Detail of existing tank
-Please choose an option-Up to 5ft5ft - 10ft10ft - 15ft15ft - 20ft20ft - 25ft25ft - 30ft
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)
