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Fax form to 1-413-772-6729

Customer: __________________________ Company: _________________________________
Reference: _________________________ Company Address: _________________________
Telephone: _________________________ __________________________________________
FAX: ________________________________ __________________________________________

  Briefly describe what the nozzle needs to do. If possible, include a sketch with dimensions (use a separate sheet, if necessary):

 
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       
                       

DATE: _______________ TIME: _________________