How did you hear about us? Date: Name:

Material to be crushed: Feed Size: Finish Product Size:

Tons to be crushed: Date to be crushed:

Name of project: Location of project:

What are the working hours?

Are there any other restrictions that would effect production?

Prevailing wage or Union Project?

Is there retainage required?

Processing by: Seegert Crushing, Inc. Contractor:

When does project go to bid?

General Contractor:

Contact Person: Mailing Address:

Phone: Fax: Cell:

Email: Website:

Note
Please include any specification if there is a spec requirement.