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CUSTOM GAUGE REQUEST FORM

Company Name ______________________________    Contact Name ________________________________

Address ____________________________________    Phone Number ________________________________

City ________________________________________    FAX Number _________________________________

State / Zip ___________________________________    E-Mail Address _______________________________



GAUGE DESCRIPTION :

DIRECTIONS: To request a custom gauge, select the “Print” button on your browser to create this form. Fill out the form as completely as possible and fax it to our Sales department @ (775) 782-1056. We will respond as quickly as possible with any questions or suggestions we have as well as price and delivery. If you have any questions or difficulties in completeing this form, don't hesitate to phone our Sales department @ (800) 991-1357.


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Perma-Cal Industries, Inc.
1742 Orbit Way
Minden, NV 89423-4114