Name:

Title:

Company Name:

Type of Business:

Phone:

Address:

City:

State:

Postal Code:

Country:

Email:

How do you prefer to be contacted?:

What size is your largest screen and your average size screen?

How many screens do you reclaim per day / week?

What type of ink do you use?

What are your present reclaiming steps?

Do you library (store with images) any screens? If so how many?

Do you require a new Hydroblaster?

Do you have a wash out booth (sink)?

Would you like to recycle your water?

Do you have a sanitary sewer connection or are you on a septic system with drain field?

How would you like to improve your reclaiming process?

Are you interested in an automatic reclaiming system?

Do you need any accessories; chemical application system, dip tank, emulsion washout booth, ink wash recycling system?

How soon will you be purchasing?

Any additional comments?