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This form is for qualification of any 3rd party wishing to do business
with Laurell Technologies Corporation - Sales
If your requirement is urgent, please fill in the form and then call us.
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 required
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Inside USA?
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Yes
No
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Is this a single one
time bid request?
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Yes
No
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Insert specific bid request, if any, here:
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First Name:
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Last Name:
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Organization:
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Street Address:
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Street Address 2:
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Street Address 3:
(internal mail stop/code) |
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Zip or Postal Code:
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City:
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State (USA only):
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Country:
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Phone #:
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FAX #:
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Company E-Mail Address:
corporate domain only |
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Personal E-Mail Address:
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Territory covered: |
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Average sale:
(in USD) |
$
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Average yearly sales:
(in USD) |
$
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Years in business: |
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Can you stock spare parts: |
Yes
No
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Can you buy & re-sell:
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Yes
No
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Can you install equipment,
provide process and repair?
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Yes
No
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State briefly your specific intentions, any references, and
all qualifications: |
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Insert line card here:
(list of products and services) |
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How did you
hear about Laurell: |
Details:
Found via Web Search - note keyword above
Technical group or society - note which above
Industry Publication - note which above
Patent search - state patent number above
Professional Referral - note who above
Use/Have Used Laurell Equipment - note where
Visited at Trade Show - note which & when
Laurell Literature - note source above
Other |
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How would you like
us to respond to you? |
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Privacy Policy
Simply stated, we do not share sensitive personal information with anyone
else. Rest assured that your e-mail address, telephone number, & other private
information stays confidential. The only time we will contact you is to
follow up on your request, an order, or follow-up a support request...
If you have a problem submitting this form,
please fill out,
and fax to: 215.699.4311
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we accept most major credit cards