Date:	(Month/Day/Year)
Legal Company Name:
Bill to Address:
Ship to Address:
Main Phone #:
Fax #:
Web site:
Federal ID # (US):
GST # (CDN):
Contact Name:	Position:	Phone # & Ext.:	e-mail:
	Injectiweld Contact
	Purchaser
	Accounts Payable
	General Manager/President
Company Information / Industry Sector:	(Rotational Molder / Fabricator / Repair etc.)
Product(s):	(Container / Pipes / Kayaks / Boxes etc.)
Other Welding Equipment in use?- Brand name(s):
Rod Consumption (~lbs / Year ):
Rod Material(s):
Rod Supplier?- :
How did you find Drader?
Magazine Ad / Other Customer / Trade Show
Internet / Other: