Address:___________________________________________________________

City :_______________________________________ State: _____________ Zip: ______________

Phone # (        ) (                    ) 

E-mail Address: ______________________________

My water is (circle one)    Sea Water      Salt Water Well      River Water    Community Well

If you know your water readings enter here:    Sodium________  Iron(Fe) _______ppm Hardness(CaCo3)__________gpg  TDS________

Have you ever sent us a water sample: (circle one)        yes                no

Do you need more information, if so please fill out our online form, or e-mail us or call

_________________________________________________________________________________
AWSW-1000SW   $26,600.00 
Required Crating $310.00
SEA WATER DESALINATION 
With TDS Quality Meter & Salinity Meter

60 Hz Motor w/316SS Pump $1,566.00
50 Hz Motor $91.00
Low-Pressure Switch $368.00
Flow Meter $105.00
Prefilter Pressure Gauges $238.00
pH Monitor $973.00
Chemical Dosing $973.00
Automatic Permeate Flush $2,260.00
High Pressure Switch $393.00
Required Crating $210.00

 (New Jersey residents add 6% sales tax) 
Call or Email For shipping Rates in the USA & Worldwide.

Payment can be made by: CHECK, VISA,  MASTER CARD.
ALPHA will notify you upon receipt of order and review all of the equipment 
ordered and verification of shipping and handling. 
Please make check payable to: ALPHA WATER SYSTEMS INC

All Desalination, Reverse Osmosis units and plants are manufactured to customers specifications and considered to be a custom order. Payment in full is required upon placing this order. An order may be cancelled within 24 hrs. after confirmation of order by calling and faxing in writing notice of cancellation and a full refund will be issued. Once the order is in production there is no cancellation or refund.

Credit card type: __________________ 
Card # ___________________________________ 
Exp. Date: ____________
Name on Card:_________________________
Signature: ______________________________________________ 
Date: _____________________

Items Ordered
__________________________
____________________________
____________________________
____________________________
____________________________
____________________________

Fax this form to us @ 973-293-8056

Mail this form to: 
Alpha Water Systems Inc 
P.O. Box 1210 
Montague, N.J. 07827

You can also call, at 973-293-7856 or 
E-Mail us with your order and info.