Customer Intake Form

Customer Information

Customer type

Individual Business/Company

Company Name

Contact Name

Email

Phone

Address

Services

Powder Coating Sandblasting Other

Other Service

Parts Description

Do they require sandblasting?

Yes No

What is the surface condition?

Raw Metal Painted Rusted Previously Coated Dirty/Oily

Preferred Colour // Finish

Requested Timeline // Deadline

Message

Will this request be recurring?

Yes No

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