Chase Industries, Inc. - Equipment Manufacturer
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Request for Information

Please provide the following information:
Name
Title
Organization
Street address
Address (continued)
City
State and Zip Code
Country
Telephone
Facsimile
E-mail
Web site address
Please provide the following product information:
Product name
Product Weight (Minimum/Maximum)
Product Width (Minimum/Maximum)
Product Length (Minimum/Maximum)
Product Height (Minimum/Maximum)
Film Choice
Customer Goal (Select any of the following options that apply)
	Display purposes Shipping protection Dust protection Theft protection Reduced labor costs Increased product output
Expected Production Rate (Parts per minute)
Individual Item/Unit Description (carton, tray, bundles, etc.)
Does this product require special handling?	Yes No
Small or loose parts to be packaged with main package?	Yes No
Multiple Items to be packaged together?	Yes No
Stacked items?	Yes No
Additional Comments

We like to work closely with our Distributors and their customers because it allows us to produce the best possible machinery for their needs. By asking you to complete this questionnaire, it is Chase Industries, Inc.'s objective to gather the information required upon which to base the Chase shrink equipment analysis, quotation, design and manufacture. We appreciate the time and effort you take to insure that the data provided is both complete and accurate. We recommend that you retain a copy of this questionnaire for your files. The information provided in this questionnaire will be used as the basis for all analysis, design, quotation, and manufacture. If your application requirements or specifications change during the course of the project, please notify Chase Industries, Inc. immediately to insure that we are current in our understanding of your needs. Thank you for completing this questionnaire. We look forward to a good business relationship. Three ways to submit application: 1.) E-MAIL form information to info@chaseusa.com 2.) Fill out form, print it and then FAX to: Chase USA at (310) 637-4506 3.) SEND via U.S. Postal Service to: Chase Industries, Inc. 1110 East Dominguez Street Carson, California 90746

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