Machine Installation Customer Detail Form

    General Information:

    Company Name (required)

    Installation Address (required)

    Installation City (required)

    Installation State/Province (required)

    Installation Postal Code (required)

    Installation Country (required)

    Region (required)

    Machine Equipment Number(s) being Installed. Provide for all machines being installed. (required)




    Machine Equipment Number(s) Previously Installed & Active. Please provide existing and active equipment numbers to update our records.




    Primary Manufacturing Management Contact:

    First Name (required)

    Last Name (required)

    Position/Title (required)

    Email (required)

    Phone Number (required)

    Primary Manufacturing Operations/Engineering Contact:

    First Name (required)

    Last Name (required)

    Position/Title (required)

    Email (required)

    Phone Number (required)

    Primary Parts/Service Purchasing Contact:

    First Name (required)

    Last Name (required)

    Position/Title (required)

    Email (required)

    Phone Number (required)

    Customer Attributes:

    Customer Classification

    Primary Industry

    Primary Universal Product (Please select a general UIC product category, particular to this customer facility)

    Secondary Universal Product (Please select a general UIC product category, particular to this customer facility)

    Primary Competitor Equipment (What other competitor equipment is currently installed at this facility, relative to the UIC equipment being installed)

    Secondary Competitor Equipment (If applicable)

    Form Submitter (Please provide your first and last name, in case we have questions about your submittal) (required)

    Submitter Email (Please provide your UIC email address) (required)

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