1.
Please check the appropriate category for your company.
01
Power Generation
02
Mining
03
Rubber/Plastic
04
Food Processing
05
Transportation
06
Construction
07
Textiles
08
Paper
09
Chemicals
10
Petroleum Products
11
Primary Metals
12
Fabricated Metals
13
Automotive Manufacturer
14
Machinery Manufacturer
15
Electrical Equipment
16
Transportation Equipment
17
Miscellaneous Manufacturing
18
Engineering Services
19
Military/Government
20
Other
2.
What is the total number of employees at this location?
6
2500 or More
5
1000-2499
4
500-999
3
250-499
2
100-249
1
99 or Less
3.
What is your primary job function?
01
Engineering
02
Engineering Mgt
03
Maintenance
04
Maintenance Mgt
05
Lubrication
06
Reliability
07
Quality Assurance
09
Corporate Mgt
10
Training
11
Other
4. Check ALL products and services you specify,
recommend, buy or approve:
Lubricants/hydraulic fluids
Lubrication systems
Lubrication hardware/fittings
Lubrication software
Filters and/or filtration units
Training
Test/diagnostic instruments
5. Please list the names and titles of individuals
at your location whom you would like us to send
a FREE subscription to MACHINERY LUBRICATION magazine:
Personal Identifier:
Audit Verification (Required)
In lieu of a signature, we require a personal identifier.
To verify that you submitted this application please
select below the month in which you were born.
Month you were born:
Please Select
Month Born
January
February
March
April
May
June
July
August
September
October
November
December