Specifications

23
Please print clearly and provide all information requested below.
Name: ____________________________________________________ Date: ______________________
Title: _________________________________________________________________________________
Firm: _________________________________________________________________________________
Street: ________________________________________________________________________________
City: ______________________________ State/Province: _______________ Zip/Postal Code: ________
Phone: __________________________ FAX: _____________________ E-mail: _____________________
Do you plan to buy or specify protective equipment: o Yes o No
Action: o Immediately o 1-6 months o 6-12 months
Industry Classification:
o Electric Utility o Generator Manufacturer
o Consulting Engineer o Contractor
o Government Agency o Industrial Firm
o Switchgear Assembler o Independent Power Producer
o Gen-set Manufacturer o Repair and Service Shop
o Gen-set Assembler o Other _____________________
Please send information on the following:
SECTION(s) SPECIFIC PRODUCT(s)
o 1 Numerical
o 2 Networked Automation
o 3 BE1 Protective
o 4 BE3 Protective
o 5 Retrofits
o 6 Autosynchronizers
o 7 Accessories
o Other
Route 143, Box 269 • Highland, IL 62249-0269 USA
Telephone: [phone] • FAX: [phone] • http://www.basler.com
From United States and Canada call Basler Info Center +1 800.562.5656
Please fax this page to +1 618.654.2351.
8 FAX SHEET