DIE-GEM EXTRUSIONS QUOTE REQUEST

Name
Title
Organization
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone
FAX
E-mail

Please provide the following product information:

Product name
Model
Version number
Product code
Serial number

Enter today's DATE:

-- MM/DD/YY

Please give a description of your profile. i.e. the color, length,
material and any other requirements that you might have?

How many parts do you require?

Please Fax a copy of any necessary drawings to (330) 784-7542 or e-mail a copy of your
profile AutoCAD.dwg to Die-GemExtrusions@die-gem.com. Confidentiality Observed.