YOUR EMAIL ADDRESS:________________________________ PHONE: ________________________

1) Create a name for this project _____________________________________________

2) What quantities would you like to have quoted?

                  Quantity 1_______     Quantity 2_______     Quantity 3_____     Quantity 4_____

3) Please assign a part number: _________________________

4) Please assign a part name: __________________________

5) Please describe part: __________________________________________________________

6) Please select a date for your RFQ to close _____________________

7) Please select a date to award your RFQ _______________________

8) Please select a desired delivery date _________________________

9) What is your delivery zip code? ______________

10) Will the freight be paid by:  ___You      ___Supplier

11) What type of material should be used for this project? _________________________________

12) Will you supply the material?   ___Yes      ___No

13) What are your standard payment terms? ___________________________________________

14) Do you have any special comments or instructions? (use section below)

15) If you would like to add a CAD file, drawings or other files please give us a call.

___________________________________________________

___________________________________________________

___________________________________________________

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Please print & complete this form and

FAX to:

Tommy Eremito

Augusta Machine & Welding, Inc.

Fax: 706-793-4163

For further assistance, please give us a call.

706-790-7820