Customer card

(*) First name :

(*) Last name :
(*) eMail adress :
(*) Company :
Adress (part 1) :
Adress (part 2) :
City :
State / Province :
Zip code :
(*) Country :
Phone :
Fax :
Business industry :

Petroleum industry
Gas industry
Chemical industry
Scientific research and development service
Colleges, universities ans professionnal school
Governmental & environemental organisation
Other :

Level of process :
Engineering
Distribution (Depot, Truck)
Transport (Shipment, pipe)
Refinnery
Exploration - Production
Manufacturer
Software & services
Other :
Job function (department) :
Purchasing
Consulting & analyst
Engineering
Management
Operations
Research & development
Sales
Other :

(*) Required fields