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Product/Service Information Request
First Name:   City:
Last Name: State/Province:
Title: Zip/Postal Code:
Company: Country:
Address1: Telephone:
Address2: Fax:
Address3: Email:

1. Do you have a business relationship with SimplexGrinnell?

Yes, currently Yes, previously No


2. What is your role in considering SimplexGrinnell products and services?

Contractor
Engineer/Architect
Dealer/Distributor
Partner/VAR
 End User: Facility Manager
IT
Dept. Mgr./Suprv./Director
Executive
Other: 


3. Do you have an active project for which you are considering SimplexGrinnell?

Yes No, I'm just collecting information
4. What is the type of project (service, retrofit/upgrade, new construction) for which you are considering SimplexGrinnell?


      SERVICE:
Sprinkler (mechanical)
Fire Detection and Alarm (low voltage - electrical)
Fire Suppression (non-water based suppression - dry chemical, range hood, gas systems)
Central Station Monitoring


      RETROFIT (upgrade):
Fire Detection and Alarm
Fire Sprinklers
Fire Suppression or Special Hazards Protection (foam, halon dump, range hoods)
Portables (fire extinguishers)
Integrated Security Applications
Building Communications/Sound
Healthcare Communications


      NEW CONSTRUCTION:
Fire Detection and Alarm
Fire Sprinklers
Fire Suppression or Special Hazards Protection (foam, halon dump, range hoods)
Portables (fire extinguishers)
Integrated Security Applications
Building Communications/Sound
Healthcare Communications
5. What is the time frame for proceeding with the project?

Less than 30 days
1 - 3 months
4 to 6 months
7+ months
6. What is the site configuration for the project?

Single Building
  Number of Floors: Sq. ft.:
 
Multiple Buildings on a Single Site
  Number of Buildings: Sq. ft.:
 
Multiple Buildings in Multiple Locations
  Number of locations: Sq. ft.:


7. How many employees do you have?

Less than 100
101 to 250
251 to 500
501+
8. Comments or Questions?


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Thanks for your interest in SimplexGrinnell solutions, products, and services.
     
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