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*First Name:
*Last Name:
Company:
Title:
*Address 1:
Address 2:
*City:
*State:
*Zip:
*Email:
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Fax:
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Questionaire:
  1. Which best describes your job function?
    1. Engineering
    2. Engineering Management
    3. Production/Manufacturing
    4. Production/Manufacturing Management
    5. General Management
    6. Quality
    7. Regulatory/Compliance
    8. Facilities/Maintenance
    9. R&D/Laboratory
    10. Other qualified personnel
  2. Which best describes your company’s type of business?
    1. Aerospace/Aircraft
    2. Automotive/Transportation
    3. Foundry/Metalworking
    4. Government/Regulatory
    5. Manufacturing – Consumer Goods
    6. Manufacturing – Industrial/Machinery
    7. Manufacturing – Electrical/Microelectronics
    8. Manufacturing – Non-Metal Products
    9. Medical Device/Pharmaceutical/Biotechnology
    10. Military/Defense
    11. Maintenance/Repair Operations
    12. Remanufacturing
    13. Suppliers/Distributors
    14. Other
  3. How many employees at this plant location?
    1. Under 20
    2. 20 to 49
    3. 50 to 99
    4. 100 to 499
    5. 500 to 999
    6. 1,000 and over
  4. Are there others at this location that should receive a FREE subscription to Process Cleaning Magazine?
    Please enter Name, Job Function (enter job function code from Question #1, above)



  5. Which of the following cleaning equipment, products and/or services will your company purchase within the next six months?
    (Select all that apply)
    1. Aqueous Cleaning Agents and/or additives
    2. Solvents
    3. Aqueous Cleaning Equipment
    4. Solvent Cleaning Equipment
    5. Ultrasonic Cleaning Equipment
    6. Blast Cleaning Equipment
    7. Drying Equipment
    8. Baskets
    9. Spray Nozzles
    10. Treatment/Recycling Equipment
    11. Analysis and Monitoring Systems
 


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