| Are you a: |
Manufacturer Distributor
Other: |
| Number of employees at this location: |
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| Primary end product manufactured or service performed at this location: |
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| Do you certify suppliers? |
Yes No |
| Are you ISO certified? |
Yes No |
| Are you currently using sensors? |
Yes No |
| (If yes, what type?) |
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| (If yes, what is the application?) |
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| Is this a new project inquiry? |
Yes No |
| (If yes, what is the application?) |
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| Estimated annual sensor usage: |
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| When do you plan to purchase a product? |
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| What action would you like Madison to take? |
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| Which product type would you like more information on? |
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| (If other:) |
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| How did you hear about us? |
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| (If other:) |
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| Notes/special requests: |
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