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*Name: Title: *Company Name: Division/Location: Address: City: *State: Zip: AK AL AR AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NE NV NH NJ NM NC ND NY OH OK OR PA RI SC SD TN TX UT VA VI VT WA WI WV WY *Telephone Number: Fax Number: *Email Address:   Sign me up for AMI's Service Tip of the Month Program

Machine Description: *Machine Brand: *Machine Model: SN: *Year of Mfg: Current Control Type/Mdl:

*Current Machine Features: (select all that apply)

Auto Index Tooling Plasma Cutting Attachment Laser Cutting Attachment Sheet Loader/Unloader Other

*Where is the machine currently located (city/state)? Is this machine currently running production? Yes  No Are you aware of any repairs that are required? Yes  No

Control Preference: (select one)

PC Based Fanuc Other

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