MagnaDrive Quote Request Form

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0 height="100%"><tr> <td valign="top" width=200 BGCOLOR="#003333" TEXT="#F7F7FF" background="133d8c00dduajq.jpg"> <bR> <bR> <bR> <bR> <div> <A HREF="index.htm" TARGET="_top" TITLE="HughesPrimeau Controls, Inc."><U><B><IMG BORDER="0" SRC="Wing0a73007700c8ffffff00.png" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Home</B></U></A></div> <div> <A HREF="id2.htm" TARGET="_top" TITLE="About Us"><U><B><IMG BORDER="0" SRC="Wing0a73007700c8ffffff00.png" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">About Us</B></U></A></div> <div> <A HREF="id3.htm" TARGET="_top" TITLE="Products and Services"><U><B><IMG BORDER="0" SRC="Wing0a73007700c8ffffff00.png" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Products and Services</B></U></A></div> <div> <A HREF="hughes_primeau_controls_line_card.htm" TARGET="_top" TITLE="Product Line Card"><U><B><IMG BORDER="0" SRC="Wing0a73007700c8ffffff00.png" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Product Line Card</B></U></A></div> <div> <A HREF="id52.htm" TARGET="_top" TITLE="Product Announcements"><U><B><IMG BORDER="0" SRC="Wing0a73007700c8ffffff00.png" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Product Announcements</B></U></A></div> <div> <A HREF="id63.htm" TARGET="_top" TITLE="Cool Orders of the Week"><U><B><IMG BORDER="0" SRC="Wing0a73007700c8ffffff00.png" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Cool Orders of the Week</B></U></A></div> <div> <A HREF="id20.htm" TARGET="_top" TITLE="Henry Hughes"><U><B><IMG BORDER="0" SRC="Wing0a73007700c8ffffff00.png" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Henry Hughes</B></U></A></div> <div> <A HREF="id55.htm" TARGET="_top" TITLE="HPC Mission Statement"><U><B><IMG BORDER="0" SRC="Wing0a73007700c8ffffff00.png" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">HPC Mission Statement</B></U></A></div> <div> <A HREF="id4.htm" TARGET="_top" TITLE="Request for More Information or a Quote"><U><B><IMG BORDER="0" SRC="Wing0a73007700c8ffffff00.png" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Request for More Information or a Quote</B></U></A></div> <div> <A HREF="id6.htm" TARGET="_top" TITLE="Map to our Office"><U><B><IMG BORDER="0" SRC="Wing0a73007700c8ffffff00.png" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Map to our Office</B></U></A></div> <div> <A HREF="id70.htm" TARGET="_top" TITLE="Cool Pictures of HPC"><U><B><IMG BORDER="0" SRC="Wing0a73007700c8ffffff00.png" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Cool Pictures of HPC</B></U></A></div> <div> <A HREF="id61.htm" TARGET="_top" TITLE="Terms Conditions"><U><B><IMG BORDER="0" SRC="Wing0a73007700c8ffffff00.png" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Terms & Conditions</B></U></A></div> <div> <A HREF="id62.htm" TARGET="_top" TITLE="Employment"><U><B><IMG BORDER="0" SRC="Wing0a73007700c8ffffff00.png" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Employment</B></U></A></div> <div> <A HREF="id60.htm" TARGET="_top" TITLE="Handy Engineering Conversions Calculato"><U><B><IMG BORDER="0" SRC="Wing0a73007700c8ffffff00.png" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Handy Engineering Conversions & Calculators</B></U></A></div> <div> <A HREF="id71.htm" TARGET="_top" TITLE="Links to our Favorite Sites"><U><B><IMG BORDER="0" SRC="Wing0a73007700c8ffffff00.png" HEIGHT="13" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Links to our Favorite Sites</B></U></A></div> </td> <td valign="top" BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <B>     </B></div> <div> <TABLE BORDER="2" CELLPADDING="2" CELLSPACING="1" WIDTH="989" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 80 ><NOBR><div> <B>Phone:       440-684-0601</B></div> <div> <B>Fax:            440-684-0656</B></div> <div> <B>Toll Free:   800-468-5404</B></div> <div> <B>Email: </B><A HREF="mailto:sales@hughes-primeau.com" TARGET="_top" TITLE="mailto:sales@hughes-primeau.com"><U><B>sales@hughes-primeau.com</B></U></A></div> </NOBR></tD> <tD VALIGN=TOP WIDTH="718"><div> <B><IMG SRC="89aad4a0.jpg" border=0 width="173" height="74" ALIGN="BOTTOM" HSPACE="0" VSPACE="0">                                                                      </B></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 188 WIDTH="252"><div> <B>Hughes-Primeau Controls celebrates the life and work of Henry G. Hughes</B></div> <div> <B>1933-2006</B></div> <div> <A HREF="id20_henry_g__hughes.htm" TARGET="_top" TITLE="Henry Hughes"><U><B><IMG SRC="75d83620.jpg" border=0 width="131" height="98" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></U></A></div> </tD> <tD VALIGN=TOP WIDTH="718"><div> <B>Hughes-Primeau Controls combines 155+ years of selling engineered heat tracing solutions with over 50 years of experience from Thermon.</B></div> <bR> <div> <B>"Committed to providing a positive Customer experience every time"</B></div> <div> <FONT SIZE="1" COLOR="#000000" FACE="Arial" > </FONT>                                                                                         <IMG SRC="8fa4f500.jpg" border=0 width="79" height="80" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><FONT SIZE="3" COLOR="#000000" FACE="Arial" ><B>                  </B></FONT>    <FONT SIZE="3" COLOR="#000000" FACE="Arial" ><B>     </B></FONT></div> <div> A Drug Free Workplace</div> <div> Copyright 2009 Hughes-Primeau Controls, Inc. All rights reserved                                      </div> </tD> </tR> </TABLE></div> <bR> <bR> <bR> <DIV ALIGN="LEFT"></DIV> <div>  <A NAME="magnadrive_drive_quote_request_form"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>MagnaDrive Drive Quote Request Form</div> <bR> <div> <IMG SRC="19951370.gif" border=0 width="337" height="55" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <bR> <div> <IMG SRC="2cc6a8d0.jpg" border=0 width="106" height="141" ALIGN="BOTTOM" HSPACE="0" VSPACE="0">    <IMG SRC="2cb05c60.gif" border=0 width="261" height="198" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> The following information is needed for a Quote. Further details will be necessary for Order Entry.</div> <div> Please include a System Performance Curve.</div> <bR> <bR> <div>  <form action="http://csbmail.globalscape.com/cgi-bin/csbmail/csbmail.pl" method="POST" enctype="application/x-www-form-urlencoded"><input type="hidden" name="tlx_SortOrder" value="FirstName,LastName,Email,Company,Phone,Fax,Horsepower,Motor Shaft,Load,Load Type,Actuator,Comments,[Custom],MailingList"><input type="hidden" name="tlx_FormIndex" value="2"><input type="hidden" name="tlx_OKMessage" value="Thank you for your request for information."><input type="hidden" name="tlx_SendMode" value="1"><input type="hidden" name="tlx_Subject" value="A request form was submitted"><input type="hidden" name="tlx_EmailTo" value="sales@hughes-primeau.com"> <table cellpadding="0" cellspacing="1" border="0" align="center"> <tr> <td align="left">First Name:<br> <input type="text" name="FirstName" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Last Name:<br> <input type="text" name="LastName" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Email:<br> <input type="text" name="Email" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Company:<br> <input type="text" name="Company" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Phone Number:<br> <input type="text" name="Phone" size="14" maxlength="14"></td> </tr> <tr> <td align="left">Fax Number:<br> <input type="text" name="Fax" size="14" maxlength="14"></td> </tr> <tr> <td align="left">Horsepower / RPM:<br> <input type="text" name="Horsepower" size="100" maxlength="200"></td> </tr> <tr> <td align="left">Motor Shaft Diameter & Length:<br> <input type="text" name="Motor Shaft" size="100" maxlength="200"></td> </tr> <tr> <td align="left">Load Peak HP, Shaft Diameter, Length:<br> <input type="text" name="Load" size="100" maxlength="200"></td> </tr> <tr> <td align="left">Load Type (Fan, Pump, etc.):<br> <input type="text" name="Load Type" size="100" maxlength="200"></td> </tr> <tr> <td align="left">Actuator, Manual, Automatic, Auto with Feedback:<br> <input type="text" name="Actuator" size="100" maxlength="200"></td> </tr> <tr> <td align="left">Comments:<br> <textarea name="Comments" rows="5" cols="30"></textarea></td> </tr> <tr> <td align="left">Want Adjustable or Non-Adjustable Coupling?:<br> <input type="text" name="[Custom]" size="100" maxlength="200"></td> </tr> <tr> <td> <input type="checkbox" name="MailingList" value="yes"> Add me to your mailing list</td> </tr> <tr> <td align="right"><input type="reset"> <input type="submit" value="Send" name="tlx_send"></td> </tr> </table> </form>  </div> <bR> <div> <A HREF="id18_non_contact_magnetic_adjustable_speed.htm" TARGET="_top" TITLE="Magnetic Adjustable Speed Drives Coupli"><U>Link back to MagnaDrive page</U></A></div> </td> </tr></table></body>