Titmus Fog Cloth Questionnaire
Please fill out and submit to receive your free fog cloth sample. |
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1. What prompted you to visit the Titmus website?:
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2. Do you have problems with lens fogging? Yes
(Please explain the conditions that cause fogging)
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3. Does your company have a prescription safety eyewear program?
Yes
No |
4. Who supplies your prescription safety glasses?
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5. Total number of employees in your company:
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6.
Yes! Please call me about a free sample!* |
| * If you choose "YES," a Titmus Representative will contact you regarding delivery of your free sample. |
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From time to time we might send you information about other Bacou-Dalloz products that may be of interest to you.
If you would prefer not to receive such information from us, please check the box at the right.
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