Customer Questionnaire

*Company
Address
City
*State
Zip
*Name
*Email
*Phone
Fax
Industry
*required

Have you ever worked with Precision Automation before? Yes No

If so; for who, when and what was the project?

How did you hear about us?

Description of project?

Are the following available?
Specs: Yes No
Sample Parts: Yes No
Drawings: Yes No

Do you have any space considerations?
Environmental concerns?

Will you be doing any work yourself?Yes No
If yes, please explain.

Will you be supplying any equipment?Yes No
If yes, please explain.

Rates now:
Rates desired:
Operators now:
Operators desired:
Do you have similar equipment? Yes No
Supplier:
Is your supplier quoting? Yes No
How many companies are bidding?
Who?
Is this project funded or is this for budgetary planning?
Estimated funded $'s for project
Projected order date:
Projected delivery date:
Who has final approval?
Are there other Team Members?



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1841 Old Cuthbert Road
Cherry Hill, NJ 08034
Phone: (856) 428-7400
Fax: (856) 428-1270
sales@precisionautomationinc.com