Equipment Evaluation Equipment Evaluation Form Sender's E-Mail Company Name Customer Address ---United StatesAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustralianAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Kinshasa)Congo Republic of the DemocraticCongo-BrazzavilleCook IslandsCosta RicaCountryCroatia (Hrvatska)CubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and Mc Donald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea NorthKorea SouthKuwaitKyrgyzstanLao PeopleÃ•s Democratic RepublicLaosLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacao S.A.R.MacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia Federated States ofMoldova Republic ofMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint BarthelemySaint HelenaSaint KittsSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakia (Slovak Republic)SloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States Minor Outlying IslandsUruguayUS Armed ForcesUzbekistanVanuatuVatican City State (Holy See)VenezuelaVietnamVirgin Islands (British)Virgin Islands (US)Wallis and Futuna IslandsWestern SaharaYemenZambiaZimbabweOther Customer Name Customer Phone Contact E-mail Equipment Model Equipment Serial # DEL Tech Date Note: This form is to be utilized when evaluating a DEL system at a customers facility. 1. How would the customer rate DEL's equipment on a scale of 1 to 10? (10 being the highest) 12345678910 Note: If the equipment is rated at an 8 or lower, please ask for a specific reason as to why the equipment was not rated higher and note this reason in the box below. 2. How would the customer rate DEL's overall customer service on a scale of 1 to 10? (10 being the highest) 12345678910 Note: If service is rated at an 8 or lower please ask for a specific reason as to why the service was not rated higher and note the reason in the box below. 3. Does the customer perform regularly scheduled maintenance on the DEL equipment? Yes No N/A 4. How often does the customer perform maintenance on the DEL equipment? 5. Has a video of the DEL equipment been taken and forwarded to customer service? Focus on any problem areas. Yes No N/A 6. Have all V-belts and drive belts been evaluated for excessive wear? Yes No N/A Note: Please list those belts that need to be replaced in the box below. 7. Have all bearings been inspected for excessive wear? Yes No N/A Note: Please list those bearings that need to be replaced in the box below. 8. In general, make a list of those components that show excessive wear. Yes No N/A Note: Please list those bearings that need to be replaced in the box below. 9. Have pictures of excessively worn components been taken and sent to DEL customer service? Yes No N/A 10. Has a 'Safety Evaluation' form been completed on the customer's equipment and submitted to DEL customer service? Yes No N/A 11. Does the customer have adequate spare parts on hand? Yes No N/A 12. Would the customer like a quotation on a 'Complete Spare Parts Kit'? Please express to the customer that purchsing a 'Kit' will save up to 30% on the price of these spare parts. Yes No N/A Note: Please note the customer contact and e-mail address of the person that should receive the spare parts kit quotation in the box below. Note: A copy of this form should be sent to DEL customer service (via website) within 24 hours of completing the sales call. All sales checklists should be reviewed during weekly sales meetings.