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ame:
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itle:
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ompany:
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ddress:
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i
ty:
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r
ovince/State:
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ip:
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hone:
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ax:
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mail:
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eb:
W
ould you be interested in IPAC for:
Cooling water treatment
Potable water treatment
Waste water treatment
De-icer
Steam boiler water treatment
Closed system water treatment
Specialty cleaners
OPUS II software
Chemcalc software
Organic based corrosion inhibitor
Lime mud additives
Ionic exchange resin
Scale inhibitors
Fireside additives
Green liquor clarification
Dust control
H
2
S control
Flocculants
Others
Any
s
pecial concerns:
Scale
Corrosion
Bio-fouling
Data and report management
Lime mud
Environment
Safety
Waste water guidelines
Fireside additive
Foaming
Green liquor clarification
H
2
S control
Dust control
Others
What is your
b
usiness?
Engineering firms
Forestry
Commercial facilities
Mining
Oil and gas
Institutions
Government
Chemical
Food Processing
Pulp and Paper
Transportation
Others
Degree of
u
rgency?
Immediate
(reply within 7 days)
Medium
(reply within 14 days)
Fair
(reply within 30 days)
What
m
edia did you hear about IPAC?
Trade show
Direct mail
Conference
Salesperson
Customer referral
Others
Who is your current supp
l
ier/sales person?
How would you like us to contact
y
ou?
Phone
Fax
Email
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