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Technical Assessment Questionnaire
Technical Assessment Questionnaire
Rustech
2020-07-12T16:46:14-04:00
Contact Information
Name of person responsible for this information
*
(First, Last)
Title
*
Company
*
Type of business
*
Email
*
Date
*
MM slash DD slash YYYY
Contact number
*
Were you referred by anyone?
*
Select option
Yes
No
If yes, please specify.
Please specify
*
Specifications of Project
Is the project in the development stage?
*
Select option
Yes
No
Manufacture name of the equipment
*
Type of metal
*
Dimensions of equipment or structure (HxLxW)
*
Weight of equipment or structure
*
In pounds
In metric tons
Level of corrosion of equipment or structure
*
Select option
Initial
Intermediary
Advanced
Location of equipment or structure
*
Select option
Open place
Closed environment
Is there a power source near the equipment or structure?
*
Select option
Yes
No
Power source
*
120/240 V
360 V
Type of environment
*
Select option
Humid
High temperatures
Sea air
Other (please specify)
Please specify
*
Chemical product?
*
Select option
Yes
No
What kind?
*
Are there vanishing points or indentations on the metal of the equipment or structure?
*
Select option
Yes
No
Unsure
Is the maintenance cost of the equipment/structure known?
*
Select option
Yes
No
How much in USD per month?
*
How much in USD per year?
*
Are there any photos available of the equipment or structure that can be shared with Rustech?
*
Select option
Yes
No
Attach below
Drop files here or
Select files
Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 20 MB.
Allowed file extensions: jpg, jpeg, gif, png, pdf
Rustech Representative Information (if applicable)
Name (First, Last)
Title
Contact Number
Email
Region
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Email
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