Coated Substrate 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

Coated Wire Extrusion
Substrate Type
Substrate OD
Coating ID
Coating OD
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.