Please fill out this form as completely as you can. A Dienes Corporation representative will be in touch with you within 2 business days regarding your quote.

Bold fields denote required information.

CONTACT & PERSONAL INFORMATION
TODAY'S DATE	AUTHOR
COMPANY
NAME	TITLE
ADDRESS	CITY
	STATE   ZIP                      COUNTRY
WORK PHONE NUMBER	FAX NUMBER
E-MAIL ADDRESS
Please contact me via:    E-MAIL    TELEPHONE
OPERATING SPECIFICATIONS
MATERIAL	BASIS WGT.
	THK.
SHEAR    SCORE    RAZOR    OTHER:
WEB WIDTH	WEB SPEED
MIN SLIT	NO. SLITS
SYSTEM INFORMATION
MANUAL    AUTO    ES TAB    LASER
COMPONENTS:
HOLDER MODEL	BOTTOM KNIFE TYPE
MOTOR DRIVEN    SHAFT DRIVEN    STACKED:
QUOTE DUE DATE
PROJECT STATUS
BUDGET	DESCRIPTION & COMMENTS
FIRM    HOT