Response Form

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Just complete this form and click SUBMIT when completed.

Name:
Company Name:
Address:
Address 2:
City
State/Province
Zip/Postal Code
Country
Email Address:
Phone #:
How did you find Exergen?
Type of business:
What is your industry?
What product line are you interested in?
What is your application?
What is your target's temperature range?
What is the ambient temperature range surrounding the sensor?
What is the critical temperature?
Environmental conditions	Clean Dirty Moist Dry Dusty Explosive Hazardous (IS sensor required) Electrical Noise Vibration Gas
Target's material surface
Describe material:
Target's size:
Distance from sensor to target:
Direct sight to target or looking via a window?	Direct Window
What is the window material?
Sensor Output desired:
Type of Input Device:
Method of heating:
Desired response time:
Target speed (if moving):
System is for:
Goal is to:
I am interested in:
Purchase Time Frame:
Contact me via:
Would you like to be on Exergen's mailing list for new product announcements, technical notes, and newsletters?	YES NO
Comments, questions, etc:
Drawings, sketches, photos, etc. are helpful, attach them here:

Response Form