Request for Quotes or Samples

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Request For Quotation

First Name:
Last Name:
Company Name:
Address:
City:
State:
Zip:
Telephone Number:
Fax Number (optional):
E-mail Address:

General Part Description / Intended Use

Material Specifications
Type of Material
Durometer (if applicable)
Density (If applicable)
Thickness (nominal)
With Adhesive Backing (PSA) Without Adhesive Backing (PSA)

Part Dimensions (please FAX drawing if available)
Overall Length
Overall Width
Any holes, cut-outs, perforations, etc (If so, please furnish details)
Desired put-up (check one)
Individual Parts Kiss-Cut rolls Ribbon Rolls (Tapes)
Other (please describe)
Anticipated purchase quantity

Anticipated purchase EAU

If design assistance is required, please furnish the following:
Temperature Exposure Range
Environmental Exposure (Ozone, UV, etc)
Fluids in Contact (Oil, fuel, water, etc)
Desired / Allowable Compression

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