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Customer Name:

Location:

Lease:

Timeline:

What is your goal for the unit?:

Please select the application of the well:

Conditions of the well:

Suction Pressure:

Discharge Pressure:

Volume/MCF Gas:

BTU:

Is H2S Present?

If yes, what is the amount of H2S?

Do you have a gas analysis done within the past 6 months?

Would you like to Rent or Purchase a compressor?

Gas or Electric?

Screw Compressor Package Options:

Liquid Ring Package Options:

For Electric Drives

Is VFD required?

Is there electricity on location currently?

If yes, how much electricity?

Scrubber Pump:

Is a Pneumatic Bypass Required?

Is Code Vessel Required?

Panel: Located On or Off Skid?

Suction Controller

Back Pressure Regulator

Are there sound concerns?

If yes, please explain:

Is transportation to location needed?

Telemetry

Insulation

Would you like Midwest to start up the unit?

Blowcase:

Hard Pipe:

Hoses: Will the customer provide the hoses?

Will the unit be inside a tank battery?

Will there be cattle by the unit?

Will there be a fence around the unit?

Will the unit be behind a locked gate:

Any additional needs/comments/concerns:

Customer Signature:

Sales Representative Signature:

Fab Signature:

Test Loop Signature:

Field Tech Signature: