Please fill in the following information:*

- Name - Title - Company - Address - City, State - Zip Code - Phone Number - Fax Number - E-mail Address

What is the primary use for JT&M's products at your company? (Check all that apply)

Assembly Punching, Crimping or Staking Forming Marking Shearing or Cut-Off Other, Please Specify

Within what industry does your firm operate? (Check all that apply)

Electronics Assembly Plastics Automotive Medical Other, Please Specify

What additional products would you like Janesville Tool and Manufacturing to provide? (Check all that apply)

Pneumatic Cylinders Punches and Dies Marking Machines Full Stroke Options on Presses Engineering and Tooling Force Monitoring Devices Servo Presses Impact Preses Indexing Tables used with JT&M Pneumatic Presses Pneumatic Slides for Penumatic Presses Other, Please Specify

Please check your principal functional responsibility. (Only one)

Corporate Executive Manufacturing Production Manufacturing Engineer Quality/Assurance/Control Product Design, Research & Development Factory Automation Purchasing Other, Please Specify

What end-use markets do you serve? (Check all that apply)

Aerospace Agricultural Equipment Appliance Industry Automotive Construction Equipment Consumer Products Electric/Electronic Equipment Food/Beverage Equipment Industrial Machinery Machine Tool/Forming Equipment Marine/Shipbuilding Medical Device Oil/Gas Industry Packing Equipment Power Generation Equipment Pulp/Paper/Processing Equipment Transportation (non-automotive) Fabricated Metal Products Tool & Die Other, Please Specify

Products of Interest. (Check all that apply)

Pneumatic Presses Manual Presses Die Sets Die Set Components Turn Key Systems using JT&M Products Other, Please Specify

Addtional/General Comments

May we contact you with another survey to better serve your needs?

Yes No

* denotes required field