Please fill out the following fields so 
that we may be of better assistance to you:

Type of Problem:
Diesel Exhaust Fumes
Vehicle Exhaust Fumes
Tobacco Smoke
Welding Smoke
Grinding Dust
Eye-Burning
Machine Shop
Dust In Computers or other Office Equipment
Oil Mist

Approximate Size of Area:
Less than 1000 sq ft.
1000-2000 sq ft.
2000-4000
4000-6000
6000-8000
8000-10000
over 10000

Interest in Specific Product:
MagneGrip
HazVent
CAC Simple Hose Drop
CAC Hose Reels
Smokeeter
Dust Hog
Dust Cat
Fresh-X-Changer
Crystal-Aire
 

Type of Application:
Fire/Rescue/EMT Department
Truck/Auto Maintenance
Office
Restaurant
Bar
Bingo Hall
Fraternal Organization
Print Shop
Light Industrial
Heavy Industrial
Bowling Alley
Vocational School
Other

What Is Your Time Frame For Solving Your Problem:
Immediate Need
Within 6 Months
6 Months - Year
Over 1 year

Are you Currently Using Any Air-cleaning Equipment?

Yes
No

If Yes, is this inquiry for:
New/different area
Same area, current equipment not doing adequate job
Same area, need additional equipment due to expansion/remodeling
 

 

Mr. Ms. Mrs.



First Name:  

 Last Name: 

 Job Title:  

   Company: 

   Address: 

      City:  St:  Zip: 

   Country: 

 Telephone:  Fax:  

     Email: 

Notes/Comments/Questions:

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