Name:   Please add your name

Title:  

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Ext: 

P/N:

Part Name:  

End Use:  

Quantity:  

Function:  

Lot:  

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Is this FDA conforming?

Yes

No

What is the maximum temperature the part(s) will withstand if heat cured? 

Do you have a coating specified?  Yes

No

Coating Quality needed: A

B

C

D

Type:  

Manufacturer:  

Product #:  

Thickness:  

Gloss %:  

Color:  

What do you want the coating to do:  

Exposure: 

Indoors

Outdoors

Both

Temperature:  Min:

Load (psi):  

Dielectric Strength:  

What is your timeline for this project?

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Zip:  

°F

Max: 

Weekly:  

Yearly:  

Exposure to Chemicals:

Exposure to Abrasives: 

Upload Drawings: 

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