PRINT-N-FAX INQUIRY from WEB

FOR MERCER FORGE CORPORATION

PRINT OUT FOLLOWING INQUIRY * FILL IN ALL INFORMATION * FAX TO THE NUMBER LISTED

FAX #: (724) 662 - 5642

ATTN: Mercer Forge Corporation Sales Department

CUSTOMER INFORMATION

DATE:__________________

CUSTOMER NAME:__________________

STREET ADDRESS:__________________

CITY:__________________

STATE:__________________

ZIP:__________________

PHONE:__________________

FAX:__________________

EMAIL:__________________

PURCHASING CONTACT:__________________

ENGINEERING CONTACT:__________________

PRODUCT INFORMATION

PART NUMBER:__________________

PART NAME:__________________

NET WEIGHT:__________________

MATERIAL:__________________

INTENDED USE:__________________

RELEASE QUANTITIES

-PER YEAR:__________________

-PER MONTH:__________________

***

ALL FORGINGS QUOTED BLACK AS FORGED

UNLESS OTHERWISE STATED

***

Check any of the Following Supplemental Operations if Applicable:

Heat Treat

Shot Blast

Flame Hardening

Magniflux %

Microalloy

Machine Operations

Others:

PPAP REQUIRED (Y/N)?__________________

DRAWING APPROVAL REQUIRED (Y/N)? __________________

PACKAGING:__________________

DATE QUOTE REQUIRED:__________________

TARGET PRICING:__________________

EXPECTED ORDER DATE:__________________

COMMENTS & SPECIFICATIONS:

(Please List All Specifications Below)