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Thank you for becoming a Comp-Ray customer! We will do our best to serve you the way you deserve. Please take a moment to fill out your Customer Information Form. Before you start, please take comfort in the fact that Comp-Ray will never sell your information to anyone. Fields marked with a * are required please.

*Customer Name:
*Street Address:
Suite Number:
*City, State:
*Zip Code:
*Phone:
Fax:
*Contact Person:
*Email Address:


Thanks! Now that we know who you are, please tell us about your facility and it's requirements.

What imaging equipment do you currently have in your facility?
What is the brand and size of the film that you use?
Is your film:
Is your film:


Almost there! Please tell us what kind of products and/or services hold your company's interests. In other words, how can we help you?

Chemisty:
Dry Laser:
Duplicating:
Film:
Mammography:
Service:
X Ray Equipment:
Other:
Is there anything else that you would like us to know?
Thank you for taking the time to fill out your Customer Information Form! Press submit to become a Comp-Ray customer and be eligible to take advantage of our many benefits!

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