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Please provide the following contact information:
Name Title Organization Address City State Zip Country Work Phone FAX E-mail
Name
Title
Organization
Work Phone
FAX
E-mail
Industry/Application Information:
What industry are you in? (check all that apply) Foundry Rubber Plastics Food Service Contractor Printing Nuclear Decon Aerospace Other If other, please specify: What is your cleaning application? (check all that apply) Core Boxes Molds Patterns Ovens Chains Motors Electrical Components Machinery Printing Equipment Hazardous Materials General Maintenance Other If other, please specify: Have you previously seen dry ice blast cleaning? Yes No Does your facility have a ground level entrance? Yes No Are your employees required to wear hearing protection? Yes No Can you provide a 1" (pipe size) air drop with a shutoff valve? Yes No How much compressed air is available at your facility? psi Horsepower What is your level of purchasing authority? Approval authority up to: $ Recommend purchase only How often do you clean? Daily Weekly Bi-Monthly Monthly Other If other, please describe?
What industry are you in?
(check all that apply)
Foundry
Rubber
Plastics
Food
Service Contractor
Printing
Nuclear Decon
Other
If other, please specify:
What is your cleaning application?
Core Boxes
Molds
Patterns
Ovens
Chains
Motors
Electrical Components
Have you previously seen dry ice blast cleaning?
Yes No
Approval authority up to:
$
Recommend purchase only
How often do you clean?
Daily Weekly
Bi-Monthly Monthly
If other, please describe?
Additional information regarding your application or industry
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