Contact Name:

Company Name:

Phone: Fax:

E-mail Address:

Mailing Address:

Shipping Address:

Quantity of parts:

Size of parts:

Size request (3/8" or 5/16"):

Give a detailed description of the material to be ground below. Include information about paper labels, metal, screws, or any other contaminant that will need to be removed.

Approximate date needed:

Will we handle freight or will you deliver?

Additional information:

If you prefer, you can print and fax the completed form to (812) 897-0123.