HYDRO LANCE CORPORATION

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CUSTOMER INFORMATION REQUEST FORM

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Customer Feasibility Questionnaire
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Client Name:__________________________________Date:______________________
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Company Name:_______________________________Department:________________
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Your Name___________________________________Your Title:_________________
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Address:_____________________________________City:______________________
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Zip Code:_____________ State/Province:_______________Country:_______________
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Telephone:___(_____)_________________________FAX:_______________________
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Name of Agent:_______________________________FAX:_______________________
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Vessel Type:_________________________________File #:____________
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                                        Preliminary Data Requirement
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Ships mission: (  ) Freight  ( ) Container  ( ) Bulk  (  ) Cruise  ( ) Ferry  (  )Excursion
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Number of passengers, less crew:____ (  ) Per trip   (  ) Per week  (  ) Per month
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Amount of cargo:  Long tons_________Tons_________ Mix Ratio:__________________
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Kind of cargo (TEU's, Auto's, other)___________________________________________
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Length of typical voyage in nautical miles:________Minimum built in range:___________
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Maximum built-in range (nm):________Desired economic cruising speed:________(Knots)
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Required maximum rated sea-state, avoiding any loss of cruise schedules:_____________
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Approximate target date to enter service:______________________, 19______________
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Jones Act driven?  (U.S.A. built): (   )Yes   (   ) No     Target life expectancy__________yrs.
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How many of the same size vessels are anticipated in the next five years?_____________
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Method of payment:_______________________________________________________
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Is leasing of the vessel, with customer paid leasehold improvements, preferred option?___
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Additional Information Here:__________________________________________________
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_________________________________________________________________________
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Form Instructions:
First, move your mouse to the top of this page, depress the left mouse button, and drag mouse to the bottom, blocking the entire page. Good.  Using your mouse, find and click  "Edit"  on your browsers tool bar, and select "Copy".   Now, 'mouse click' either of the E-mail addresses below.  Your browser's E-Mail blank page will appear.  With your cursor, first click on, and at the top, of your blank E-mail page.  Now  move the cursor,  to select Edit, from your E-Mail tool bar, and then select "Paste".   The form is now on your E-mail page.  Depress the "Insert" key on your keyboard to the "typeover" mode.  Fill out the form. When finished, mouse click the "Send" button on your E-mail tool bar.  Note: Questions or requests submitted, without completing this form, may be discarded.                    
 
.......Or, 'BLOCK' and PRINT THIS PAGE, COMPLETE AND MAIL, E-Mail,  OR FAX TO:
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                                HYDRO LANCE ENGINEERING
                                Customer Service, Technical
                                c/o
the Night Shifttm
                                1867 Gaviota Court
                                Simi Valley, California  93065
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Fax: (760) 365-2961
                                E-Mail: 
oooowl@earthlink.net
                                E-Mail: hydrorobt@aol.com

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