Fairchild Industrial
Products Company
3920 Westpoint Blvd.
Winston-Salem, NC 27103
Phone: (336) 659-3400
Fax: (336) 659-9323

 
   
  Quotation Request
   
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Contact Information (* = Required Fields)
 
*First Name  
*Last Name  
Title  
*Company Name  
*Email  
*Address 1  
Address 2  
P.O. Box  
*City  
*State  
Country  
*Zip  
Phone  
Fax  
 

 
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This Inquiry is in Reference to:
 
  A project (please specify name, # units, date required in field below)
  An Ongoing need (please specify estimated annual usage in field below)
  Assistance with application (please specify in field below)
 

 
Plan to Purchase in:
 
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Purchase Authority:
 
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The following contact has the authority to purchase:
         
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Business Activity:
 
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  Company Type  
 
 
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