Senix® Detailed Info Request
US & Canada Only

Form Guidelines: RED labeled fields are required. Enter 'none' or '?' if no answer.
The more information you provide in the form below the better Senix® can serve you.
Or call 800-677-3649 or 802-453-5522 or FAX 802-453-2549 for direct support.

I Want Senix® to do the Following: (check all that apply)

Action(s) requested:

Mail catalog + any info appropriate for my application
Have an applications engineer call me
Quote a product for this application

I am in a hurry.
Please also do these:

Send appropriate info by FAX
Send appropriate info by e-mail
Please call ASAP!

I am interested in the following products:
Any-please recommend
Senix® ToughSonic product line
Senix® Dry Environment product line
Senix® Modular product line
Custom / OEM

About Contacting Me

Organization:  
Organization's website:  
 
Name:
Address:
Address2:
Address3:
City, State Zip/Postal:      
Country: US    Canada
Telephone: Extension:
FAX:
E-Mail Address:  

Preferred method for routine contact: 

No Preference   Phone   FAX   e-mail

My Industry
Aerospace Converting Medical Transportation
Agriculture Consulting Metals Water/Wastewater
Automotive Education Printing
Building Materials      Entertainment Pulp & Paper
Chemicals/Petro. Machinery (custom) Rubber

Where I First Discovered Senix®

   
1. Current Status: Senix customer   Just found Senix
   
2. Choose One

3. Then, if you recall, answer the question in the Answer Box:
 
 
Web Search Engine  If so, which engine? Answer box:
 
Magazine Ad If magazine, which one?
Referral If referral, by whom?
Trade Show If show, which one?
Sales Organization Name of sales agent?
Thomas Register - Book What product category?
Thomas Register - Internet What product category?
Thomas Register on CD What product category?
Other From where or whom?
 

About My Needs
Time Frame Yearly Usage (units) Customer Type
Immediate
3-6 months
6+ months
For Reference Files		 No current application
1-2
3-10
11-49
50-99
100+
1000+		 In Plant/User
OEM/Integrator
Sales Organization
Consultant (referring others)
University/Museum

About My Application
Application Type:

Enter Below if not on this list

Sensor Location: Office/Lab  Factory  Shed  Outdoor  Outdoor-snow/ice
Sensor Outputs
(Check all that apply)		 Power input(s)
 (Check all available)		 Acceptable Package Sizes
 (Check all that apply)
0-10 VDC
4-20 ma current loop
Relays/Contacts/Switches
RS-232 serial data
RS-485 serial data
Undetermined 		 12 VDC
15 VDC
24 VDC
Any DC
115VAC
230VAC
Undetermined		 Not a factor
Miniature (size of finger)
Compact (size of hand)
Larger (terminal blocks, conduit)
Please provide any additional information that will help us understand your application.
(256 characters max, which about fills this box)