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Grinding Media Quotation Request Form

* Required fields  
* Company Name:
* Mailing Address:
* City:
* State/Province:
* Zip/Postal Code:
* Country:
Contact Information
* Contact Name:
* Title:
* Phone:
* Email Address:

What mill are you using?
Mill Manufacturer:
Mill Size:
Mill Model:
What material are you grinding?
What media do you require?
What size media?
What quantity?
How Did You Hear About Us? (check all that apply)
  Google – list keyword if remembered:
Magazine Ad – name of publication:
Press Release
Trade Show – name of show:
Bing Search
Yahoo! Search
Referral from colleague
Past customer
Additional Comments:

Quotation Standards:
All grinding media is quoted F.O.B. Union Process.
Grinding media quotations are valid for 30 days from date of quote.
Payment terms will be specified on the formal quote.

Security Code:
Please enter the words you see in the box, in order and separated by a space.