Additional Information and Quotation Request Form

Filling out this form completely will help us answer your questions and send you a quotation faster:

NOTE: We will ONLY respond using email for all international inquiries. Please do NOT ask us to contact you via any other means.

Machines requiring 220-240 VAC 50/60 Hz power are no longer available! We can only build 110-120 VAC 60 Hz machines. You will need to purchase a STEP-DOWN transformer at your end to use with the machine and it will function very well.

Your Name:*

Company Name:

Street Address:

City:

State:

Zip Code:

Country:

Voice Phone Number:

Email Address:*

Application:

Select One Please Invoice Canceling Mail Receipting ID or Credit Card Canceling Source Document Marking Coupon Book Canceling General Document Marking Dating Documents X-ray Dating Numbering Bingo Card Validation Other

Have you used a perforator before?

Yes No

How soon are you considering a purchase?

Select One Please Right Away! Within Next 6 Months Not Sure Budget Purposes Only Next Year

How would you be paying for your purchase?

Select One Please Purchase Order Cash Wire Transfer (EFT) Company Check Not Sure

Will you require the DATE?

Yes No

If Yes for DATE, what format?

Select One Please DD.MM.YY (overseas most common) MM.DD.YY (most common) DD.MM.YYYY MM.DD.YYYY

If you require the DATE, it is normally done with 6 digits and is ALWAYS the second line of perforation.
It can ONLY be changed manually, but it is very simple to do.

Will you require any inscription for the FIRST line? If yes, what?

No inscription on first line PAID REC'D VOID CANCL'D Other

If "Other", what do you want to have there?

Will you want any inscription in the THIRD line? If yes, what?

Do you need the FIRST line to be changeable?

Yes No

If Yes, what do you need it to say?

If this machine is for a NUMBERING application, other than the date, how many digits do you need?

Is the address above where you would be having the perforator shipped to?

Yes No

How many units are you looking to purchase?

Select One Please 1 2 3 4 5 6-9 10+

What is your POWER requirement?

Select One Please 120 VAC 60 Hz 230 VAC 50-60 Hz

Please enter any other specific questions or requirements you have:*

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