Name

Title

Company

Street Address

City

State

Zip Code

Phone

Fax

E-Mail

Type of Industry

Have you purchased from QCT in the past?

Yes No

If yes, which distributor

Approximate annual purchase

Product previously purchased

Comments

Purchasing Plans

Immediate, have someone contact me for more information
3-6 months
Within 1 year
No plans, needs information for future reference

Yes, I would like to be signed up for the QCT Email Club. I understand that I will occasionally receive information on new QCT products, as well as technical articles and industry trends. I also realize that I can opt out of the Email Club at any time.


 



 

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Quality built into products and services, Customer-centric ethics, Team based efforts, Efficient process design, and your Reliable supplier.  Are you a "QCTer"?