| Telephone: |
|
| Fax: |
|
| Client Company: |
|
| Street Address: |
|
| City: |
|
| State: |
|
| Zip: |
|
| Email: |
|
| |
Summary of Application
(include materials used, current method, adhesive, reason
for change, etc.) |
|
| |
|
If you would like to submit more information to further develop your
information-request please fill in the fields below:
|
|
If not, please click this submit button
|
| |
What problem(s) are we
solving
(if more than 1 rank them 1, 2, 3, etc.)? |
|
| |
Curing Options
(1 or 2 part, UV curing, fixture & mixture life times,
time in station and
stations available to cure and dispense): |
|
| |
Uncured Requirements
(Viscosity, color, odor, etc) |
|
| |
Cured Material Requirements
(strengths, Temperature, Color if applicable, Other
Environmental conditions): |
|
| |
| Pricing Requirements (or
target cost per part with volume/part): |
|
| |
| Miscellaneous Requirements
Not Covered Above: |
|
| |
|
