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Title:
Company:
First Name:
Position:
Last Name:
Address:
Phone:
City:
Alternate Phone:
State:
Fax:
Zip:
Email:
Country:
What type of part is to be protected:
Approximate size of part:
Ferrous or Non-Ferrous:
Ferrous
Non-Ferrous
Shape of part:
Are parts clean and dry?
Yes
No
If not, what is on part?
Any current rust preventative?
Duration of protection required?
Transportation from:
Transportation to:
Parts wrapped or exposed to atmosphere?
Wrapped
Exposed
Parts packaged individually or in bulk:
Individually
Bulk
Description of current VCI product if used:
Size of packaging needed, if known:
Special packaging requirements:
Quantity of part packaged per month:
Storage conditions:
Indoors
Outdoors
Heated
Covered
What is unsatisfactory about our current process, method, or product: