| First
Name: |
|
| Last
Name: |
|
| Address: |
|
| City: |
|
| State: |
|
| Zip
Code: |
|
| Country: |
|
| E-mail
address: |
|
| Company
Name: |
|
| Phone
Number: |
|
|
| Equipment
Type: |
|
|
| Engine
or Hydraulics: |
|
|
| Change
Intervals: |
|
|
| Lube
analysis program in place? |
|
|
| Are
you interested in becoming a Filtakleen dealer? |
|
|
| Estimated
monthly waste oil in gallons: |
|
|
| Estimated
monthly cost of oil & filter changes: |
|
|
| Estimated
monthly cost labor: |
|
|
| Does
your company practice Proactive Maintenance? |
|
|
| Do
you use fuel additives? |
|
|
| Have
you considered using automatic lubrication of your moving greasable
equipment? |
|
|
| How
did you find us? |
|
| |
| Comments: |
|
| |
 |
|
|
|
|
| |
| |
| |