CD Inspection
USI
PQV
TCI
OCR
Presence

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Required fields are in BOLD. First name: Last name:   Company: Title:   Mailing address: Mail Stop:   City State/Province Select One Alberta Alaska Alabama Arkansas Arizona British Columbia California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Manitoba Maryland Maine Michigan Minnesota Missouri Mississippi Montana New Brunswick North Carolina North Dakota Nebraska Newfoundland New Hampshire New Jersey New Mexico Nova Scotia Northwest Territories Nevada New York Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Quebec Puerto Rico Rhode Island South Carolina South Dakota Saskatchewan Tennessee Texas Utah Virginia US Virgin Islands Vermont Washington Wisconsin West Virginia Wyoming Yukon Territories Other Zip/Postal Code: Country: Telephone number: (Area/Country Code) Fax number: (Area/Country Code) E-mail address:     May we contact you via email? yes no
1. How would you classify your company industry?
	Aerospace					General manufacturing
	Automotive					Medical device
	Bottling/canning					Packaging
	Consumer products					Pharmaceutical
	Consumer/office electronics					Printing
	Electronics					Semiconductor
	Food & Beverage					Other
2. How would you classify your company type?
	End User					OEM
	Machine Builder					System Integrator
	Other
3. How many vision systems have been installed at your facility within the last five years?
	None					3 - 9
	1 - 2					10 or more
4. Approximately how many systems do you intend to purchase over the next 12 months?
	None					3 - 9
	1 - 2					10 or more
5. How much do you plan to budget for machine vision projects over the next 12 months?
	Less than $5,000					Between $25,000 - $100,000
	Between $5,000 - $25,000					More than $100,000
6. Do you have an active project that you believe can be solved by a vision system?
	Yes
	No
7. Do you have a deadline by which you are looking to purchase a solution?
	No					Yes, within 30 days
	Yes, between 1 and 3 months					Yes, over 3 months
8a. How will you justify the cost of this project?
	Labor savings					Reduced scrap rate
	Improve quality of the product I produce					Increase production rates
	Safety or liability concerns					Impossible to produce my product without machine vision
	Don't know
8b. Please elaborate:
9. Part to be inspected:
10. Application description:
11. Comments