Data collection sheet to recommend
Polyelectrolyte / Flocculant

NEW CLIENT / NEW APPLICATION

S.No. Description Details
1 Client name with full postal address and pin code
  Phone
  Fax
  Email
2 Attention to whom
Name
Designation
3 Subject / Purpose
4 Our Sales Person ( s) involved
5 Discussion Over Phone / Direct site / lab trial Phone Direct Site Visit
6 Discussed with whom
Name
Designation
7 Offer to be sent through Fax / Courier If fax : Fax Number Courier Fax         Fax No.
8 Copies to be sent to ( ie. CC to )
Name
Designation
9 Type of process where polyelectrolyte is required
10 Nature of the present problem, faced in the process
11 Characteristics of the process liquor to be treated
12 Schematic diagram of the process on both in the upstream and downstream areas (One file of maximum                                      size 1MB can be Uploaded)
13 Details of the findings of the lab trial, if any (One file of maximum                                      size 1MB can be Uploaded)
  Product (s) Recommended
  Dosage
  Rate/kg
  Special Instruction (If any)
  Date of Visit by you
  Offer sent Date to Client