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Project
Information Request Form
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required
Contact Information
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Your Name:
*
Company:
Address:
City:
State:
Zip Code:
*
Phone:
*
E-Mail:
I prefer to be contacted by:
Phone
E-Mail
What does your company or facility do?
Where will the ESD Floor be used?
Manufacturing
Call Center
Test
Command Center
Circuit Boards
Flight Control Tower
R & D
Police or Fire Station
Lab
University
Server Room/Data Center
Clean Room
Bank
Other
Which ESD product(s) are you interested in learning more about?
Vinyl Tile
Epoxy
Carpet Tile
Broadloom Carpet
Wax
Carpet over Access Floor Panels
Floor Runners
Floor Mats
Rubber
Paint
When do you plan to begin this project?
Immediately
Within a Month
1 - 3 Months
3 - 6 Months
New Building, Not Yet Built
ESD Flooring is a Wish
Who will do the work?
We need help with both material and installation.
We would like help finding an installer.
We've found a flooring contractor
We can handle the job ourselves
Who will test the floor?
Internal Engineer
Installer/Contractor
Consultant
ESD Specialist
Would you like to see project photographs?
Yes
No
Please tell us what you're interested in seeing.
Application Information
What is the square footage of the job?
≥ 1000
≥ 3000
10,000+
20,000+
What is the surface to be covered?
If you are installing over an existing floor, what type of floor will you be covering?
Concrete
Epoxy
Wood
Old Tile
How would you describe the surface to be covered?
Smooth
Rough
Severely damaged surface
What is the elevation of the floor?
Above ground
Below ground
At ground level
Ergonomic Preferences
Please check all that apply:
Slip Resistance
Easy Rolling of Carts
Anti-Fatigue
No Plasticizers
Sound Absorption
No VOCs
Aesthetic Preferences
Please check all that apply:
Prefer Bright White
Easy on the Eyes
Prefer Darker Color to Hide Soiling
Reflective
No Seams
Want State-of-the-art Appearance
Need Aisles Marked
Smooth Surface
Rough Surface
Other
Maintenance Requirements
Please check all that apply:
Least Maintenance Possible
Don't Mind Waxing
Easy to Clean
Willing to buff
Easy to Repair
Vacuum Only
We're Messy
Electrical Specifications
Must Meet ANSI ESD S.20.20
Whatever is Cheapest
Looking for a Range. Please Indicate Range:
How important a consideration is cost?
Extremely Important
Cost is our only consideration.
Very Important
Cost is among our toptwo or three considerations.
Important
Cost is equal in importance toquality and performance.
Moderately Important
We care aboutcost, but performace outweighs cost.
Not Important
Quality and performance are all that matters. We want the best.
Is there anything else we should know?
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