Information Request Form
Please complete the form below to receive information on the UBM®, The Machine That Makes Buildings.
First Name:
*
Last Name:
*
E-mail Address:
*
Website Address:
Company/Organization:
Title:
Industry:
Address 1:
*
Address 2:
City:
*
State:
*
Zip Code:
*
Country:
*
Telephone Number:
*
Fax Number:
*Required
Advertisement: Name & Date of Publication
Personal Referral
Other Source
Did you see our product?
Where?
A
JOB TITLE/FUNCTION
*
(
Please Select One
)
Chairman/CEO/Managing Director
Partner
Sole Owner
Executive Officer
Government Official
Consultant
B
PRIMARY COMPANY BUSINESS
*
(
Please Select One
)
Industry / Manufacturing
Product:
Import / Export
Product:
Government Agency
Please Specify:
Educational / Research Institute
Please Specify:
Construction
General Construction
Steel Construction
Agent / Representative
Other
Please Specify:
C
NUMBER OF EMPLOYEES
*
(
Please Select One
)
1 - 20
21 - 50
51- 200
OVER 200
D
ANNUAL REVENUE
*
(
Please Select One
)
UNDER US $500,000
$500,000 - $2M
$2M - $10M
$10M - $20M
OVER $20 MILLION
How would you prefer to receive information from us?
Email
Mail
Phone Call Requested
Which products are you interested in?
Ultimate Building Machine® System
Training
Maintenance
Spare Parts
I am interested in the following solutions(s):
(choose all that apply)
Agricultural
Military
Industrial
Humanitarian Aid
Commercial/Retail
Governmental
How are these services currently provided to you?
Use the space below to provide our sales department with any additional information.
© 2004 - 2012 M.I.C. Industries, Inc.
All Rights Reserved.
M.I.C. Industries, Inc. is the sole worldwide manufacturer and registered trademark owner
of the Ultimate Building Machine® (UBM®), Automatic Building Machine® (ABM®),
K-Span®, Super-Span®, Super K-Span®, and other complementary products.
