N.S. Machine Corporation

Fax Request Form

1503 S. Ankeny Blvd Ankeny, Iowa 50023	Print this form and fax to 515-964-7484
Phone: 515-964-1290	Print page 2 for additional listings

Where did you learn of NS Machine?

Publications and Internet Directories	Search Engines
____ Surplus Record	____ All the Web	____ Hot Bot	____ Open Directory
____ Locator	____ Alta Vista	____ iWon	____ Overture
____ Used Equip. Directory	____ AOL	____ Looksmart	____ Teoma
____ MachineTools.com	____ Ask Jeeves	____ Lycos	____ Webcrawler
____ Thomas Register	____ Excite	____ MSN	____ Yahoo
____ Other_____________________	____ Google	____ Northern Light	____ Other_________

Name: _________________________________	Job Title : _______________________________________
Company name: ______________________________________________________________________________
Address: ____________________________________________________________________________________
City: __________________________________	State or Province: _____________________________
Country: __________________________________		Postal code: _______________________________

Phone: _________________________

Fax: __________________________

Email: ________________________

Check one: _____ Machine Wanted _____ Machine For Sale
Machine: _____________________________________________________	Manufacturer: ____________________________________________________
Model #: _____________________________________________________	Serial #: ________________________________________________________
Age: _________________________________________________________	Condition: ______________________________________________________
Specificaitons: __________________________________________________________________________________________________________________
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FOR SELLERS:
Asking price: _____________________________________________________________________________
Can machine be seen under power? ___________________________________________________________
When can machine be purchased / shipped? _____________________________________________________
FOR BUYERS:
Price range: _______________________________________________________________________________
When do you need this machine? ______________________________________________________________

-COMMENTS-

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