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Request for Quote

Submission ID #

Your Information

Your Name(Required)

First Last

Your Company(Required)

Your Email(Required)

Your Role(Required)

End User

Distributor

Gibson RSM

Date(Required)

MM slash DD slash YYYY

Regional Manager(Required)

Customer

Customer(Required)

Customer Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Contact Name(Required)

First Last

Phone(Required)

Extension

Email(Required)

Distributor (if known)

Company(Required)

Enter "n/a" into the Distributor fields if unknown

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Contact(Required)

First Last

Phone(Required)

Extension

Email(Required)

Parts

Description(Required)

Largest Part Size Length(Required)

Largest Part Size Width(Required)

Largest Part Size Height(Required)

Smallest Part Length(Required)

Smallest Part Width(Required)

Smallest Part Height(Required)

Weight (lbs)(Required)

Finish Specification

Surface Finish

Anchor

Peening

Etching

Coating Removal

Other

Process

Objective (application)(Required)

Production Rate(Required)

Operation Before Blast

Operation After Blast

Media Type(Required)

Media Size(Required)

Finish/Peening Requirement(Required)

Part Coverage(Required)

100%

Other

Part Masking/ Overblast Requirement(Required)

Screener(Required)

Yes

No

If Yes, Media Spec(Required)

Auto Media Rep. Sys.(Required)

Yes

No

Option

Recipes(Required)

Yes

No

Option

Recipes Quantity(Required)

Include Speeds?(Required)

Yes

No

Option

Elevation(Required)

System Specs:

System Type(Required)

Specify Other System Type

Load/Unload(Required)

Utilities/Requirements:

Customer Specification(Required)

Customer Budget(Required)

Electrical Supply(Required)

Specify Other Electrical Supply

Paint(Required)

Gibson Grey (standard)

Special (coupon required)

Plant Space Available (WxLxH)(Required)

Quote Information:

Quote Type(Required)

Quote Due Date(Required)

MM slash DD slash YYYY

Proposal Drawing Required?

Yes

No

Estimated Order Date

MM slash DD slash YYYY

Coments:

Comments

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Wheel Blast Equipment

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7988 Centerpoint Drive
Suite 400
Indianapolis, Indiana 46256

Toll-Free: 888-867-1619
Phone: 317-758-5520
Fax: 317-758-6775
Email:

For Air Blast Solutions including Manual Blast Cabinets, Blast Rooms, Automated and Robotic Systems, visit our parent company, Empire Abrasive Equipment

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