To best determine your price structure, please take a moment to answer the following questions.  


   (4 to 12 charactors)
  *RE-ENTER Password
  *Fisrt Name
  *Last Name
 (  ) -
 (  ) -
  *Company Name
  *Business/ Billing
  Province/ State
  *1. Company Category
  *2. Industry
  *3. Type of Business
  *4. Products in which you
        are interested
  Secondary 1:
  Secondary 2:

  *Is this your 1st timepurchase of Fuji Electric
    Distribution and Control products?

    If not,where did you previously purchase the products?
  Yes No
   Provide names of the company:
  *Please indicate your order type.
  One Time Small MRO Use
  One Time Project Use
  Continuing Business
  *Please provide your
 estimated annual usage.
  *Is credit card payment acceptable?
  Yes   No. (NET 30 DAYS Prefer)
   Request/ Question/ Comments