Company*

Name*

Address 1 *

Title*

Address 2 

City*

State / Province *

Phone*

Zip / Postal Code *

Fax

Country *

Email*

Preferred contact method 

EmailPhoneFax

Urgency of Requested Info

Immediate3-5 days5-7 days

Type of Manufacturer

GusmerGusmer AdmiralGracoGlas-CraftTAHCustom Equipment

Type of Equipment

NoneSprayPourInjectFrothMixing HeadsMotionless MixerDispensing Valve/gunStorage ContainerCustomOther

Comments

1. How do you want to dispense the material? SprayPourInjectFroth
2. Is the material a Single or Plural Component?
3. If it is a Plural Component what is the Ratio by volume?
4. What is the CPS of the components at 70F?    
5. Are any fillers or pigments used in the material? How much? Are they abrasive? Do they require agitation?
6. Are heaters required for dispensing and properly mixing the material components?

   YesNoDon't Know

7. What size part are you spraying, injecting or pouring?
8. If you are molding your parts, are you using a closed or   open type mold?
9. What type of storage containers are you going to use for the material?

   PailsDrumsVessels

10. Will the material be stored outside or inside? Or will it be temperature controlled 70 - 80 F?