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Technology Training		 Technology TakeOuts TechToberFest 2008

Applied Controls Technical Assistance Request Form

This request will be reviewed by our Technical Services department. Responses will generally be within 1 business day. NOTE: Some services and assistance may be on a fee basis, which will be detailed in the response.

Please provide the following contact information:

       Your Name 
      Your Title 
    Company Name 
  Street Address 
 Address (cont.) 
            City 
           State 
        Zip Code 
      Work Phone 
      Fax Number 
  E-Mail Address

Would you like us to contact you by phone, fax or e-mail:

Phone Fax E-Mail

Please answer a few questions to help us better understand your application:

New Application         Existing Application

What product types are involved in your application ? (Check all applicable)

Drives / Motors / Motion Control    HMI / OIT / MMI
PLCs / Networking    Process Control
Programming Software SCADA
Sensors (Proximity, Photo, Flow) Timers / Counters / Meters

What value added service(s) would help on this application ? (Check all applicable)

AutoCad Drawings       Custom Cabling and Wiring
Custom Training Course(s) Technical Field Service Call
Networking Assistance On-Site System Installation/Startup
Other: Programming Assistance
Proof-Of-Concept (Application Demo) System Staging and/or Testing
Technical Telephone Support

Detailed Application Information and/or Questions:

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