FAX Quick Quote Form

Print / fill out and fax this form to Modco for a quick response or quotation on your specific requirements. Fill in only the specifications that you really require to avoid any custom or "NRE" charges. Most requests will not incur additional cost above our standard pricing.

To:  Modco,Inc.  Toll Free: 1-800-672-4552
Fax:  1-775-331-6266       Voice: 1-775-331-2442  
E-Mail: sales@modcoinc.com
Date:	__________________________  No of Pages:________________________________
From:      ___________________________ Company: __________________________________
Address: ____________________________City:          _________________________________
State:     ____________________________ Zip:           _________________________________
Fax:       ____________________________ Phone:      _____________________Email:__________________