Please provide the following contact information:
Contact Information
First Name:
Last Name:
Company :
Phone:
Fax:
Mobile
e-mail:
Website URL:
Shipping Information
Attention:
Address Equipment is to Ship to:
City / Suburb / Town:
State / Province:
ZIP / Postal Code:
Country:
Billing Information
(If Available OR Leave blank if same as above)
Attention:
Billing Address:
City / Suburb / Town:
State / Province:
ZIP / Postal Code:
Country:
i
Please provide the following equipment information:
pment information:
Your Application:
- Select your application -
Coal
Ground Water
Base Metal
Engineering
Other Please Specify:
:
What will the system be required for:
- Select your requirement -
Exploration
Development
Other Please Specify:
Depth Requirement:
- Select your depth requirement -
300m or 985ft
500m or 1645ft
1000m or 3281ft
1500m or 4921ft
2000m or 6562ft
2500m or 8202ft
3000m or 9843ft
Other Please Specify:
Winch Type:
- Select your winch type -
Four conductor cable
Single conductor cable
Other Please Specify:
Portability, where is the system to be used:
- Select portability type -
Dedicated Vehicle
Portable
Other Please Specify:
Voltage Required:
- Select your voltage requirement -
12 V DC
115 VAC
240 VAC
Other Please Specify:
Special Requirements:
Comments:
Auslog Pty Ltd
Unit 9, 29 Collinsvale St
Rocklea, QLD, 4106
Brisbane, Australia
Tel: +61 7 3277 4671
Fax: +61 7 3277 4672
e-mail: auslog@auslog.com.au
© 2005 Auslog Pty Ltd
