Steel Sales & Supplies Contact Form

Name:

Company Name:

Job Title:

Phone:

E-Mail:

Address:

What product(s) do you grow, pack or ship?

Which product line are you interested in?
 Industrial Supplies
Power Transmissions
Steel Sales
Other

What is the description of the item(s)? (Please be specific, i.e.; Model #, Part #, dimensions, grade, etc.):

What is the quantity amount(s)? (Please specify the unit of measure, i.e.: ea. ,ft., sq. ft., gals., lbs., etc.)

If you have any specific requests, please list the information below:

How will you be receiving the order?
Customer Pick-Up
Truck Delivery
Commercial Freight

(Note: Truck delivery area is designated to a 45 mile radius from our main office in Immokalee, Fl)

If requesting truck delivery, when would you like the items delivered? (Please enter the date):
/ /

If commercial freight delivery is required, how would you like the item(s) shipped?
Regular Ground
Next Day
2nd Day
3rd Day

(Note: Shipping restrictions may apply)

What is the delivery address?

How did you hear about us?
 Search Engine
Mailer
Convention
Friend
Other Companies
Other

Would you be interested in receiving information on our other products and services such as Citrus Truck Haulers, conveyors and conveyor components, re-stackers and de-stackers, elevators, curved conveyors, etc.?
 Yes
No

Failure to give complete information may result in our not responding. Please make sure you have answered all questions (including how we may contact you) before submitting this form.

Any information collected on this form is for Salazar Machine & Steel, Inc. purposes only and will not be given to any third parties.

All Rights Reserved

Salazar Machine & Steel, Inc.
160 Airpark Blvd., #109
Immokalee, FL 34142

P: (239) 657-2325
F: (239) 658-2513