3 Layer Co-Extrusion Request Form

PART ONE - ORDER INFORMATION
Request Date
Requester Company
Requester First Name
Requester Last Name
Phone
Purchase Order #
Reference Document
Product Application
Ship To
PART TWO - MATERIAL DESCRIPTION
WT%
POLYMER TYPE
TRADE NAME
GRADE NUMBER
ADDITIVE / COLORANT
%
%
%
%
PART THREE - PACKAGING
Final Quantity
[Select One]
Qty Reel(s)         Length on Reel each 

-OR-

Qty of cut Pieces         Piece Length
PART FOUR - PRODUCT SPECIFICATION

Three Layer Co-Extrusion
ID
OD
Wall (W1)
Wall (W2)
Wall (W3)
Concentricity Greater than or eqaul to %
Maximum Ovality Less than or equal to
Comments 

You will receive a cost quotation via email within 24-36 hours or less.