Full name of firm

Adress:
Postal code 

City

Street (& house number)

Phone number

Fax number


Are You interested in buying/leasing of a clock synchronized with atomic mother-clock?
Yes and we will consider any offer on the spot.
Yes, but not durig this year.
We cannot give you reply, because we don't know anything about clock synchronized with atomic mother-clock.
Our clock is good enought and we don't plan to modernize it.
We are not interested because the lock of founds.

Place of clock installing
Wall thickniss:
        cm
Amount of faces:  
        1 2 3 4 other
Heigh on which clock should be installed: 
        m
Lenght of minute-hand:
        cm
Diameter of clock-face:
        cm
Is there any high voltage (220V) plug-in?
        yes       no       I don't know

Exploatation of existing clock
Condition of existing clockwork:
        perfect good average poor doesn't exist
Condition of clock faces and hands:
        perfect good average poor doesn't exist
Is there any acces to clocs hands from inside of the disc?
        yes       no       I don't know

How often clock must be set? 

How often does clock need to be repaired (it breaks)? 

Average cost of repair:

Estimated yearly working cost:


Name and Surname (neccesary)