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28101 SOUTH  YATES AVE  BEECHER, ILLINOIS  60401 PHONE: 708.946.9595  FAX: 708. 946.7898

Information Request Form

Please Complete This Form To Request Additional Information.

NOTE: Fields marked in RED are MANDATORY.

YES!  We’re very interested in your Storage Structures.

We envision our initial application to be for your...

  Dome-Style Structures        Barn-Style Structures     Fabric-Style Structures

                First/ Last Name 

                                   Title 

                            Company

                            Address 1

                            Address 2

                                     City      

                                  State    Zip

                          Area Code Phone 

                         Area Code  Fax     

                                 Email 

The following information will help us to define your need and determine the most appropriate structure size to accommodate your operation.
How Do You Presently Store Your Salt/Sand? 

Approximate Tonnage of Salt / Sand Used per Winter?     

Number of Road Miles within Your Service Responsibility?

Is Land Allocated for Structure?                                                 Yes. No

Is a ‘Pad’ In-Place on Grounds?                                                  Yes. No

What is your Budget Allocation?  

What is your Projected Timetable?                                             0-3 Months . . . . 7-12 Months
                                                                                                    4-6 Months
. . . . Longer than 12 months

Would You PREFER to Load Inside Building?                             Yes. No

Within the Past Year,

Have You Been Cited by EPA for Groundwater Contamination? Yes. No

 

Other Types of Building (s) You’re Considering?  

 

How Did You Hear of  BULK STORAGE ?

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©INFORMATION AGE INC. 2006