COMPANY/CONTACT INFORMATION

Company

Address City State AL AK AS AZ AR CA CO CT DE DC FM FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WV WI WY Zip

Name Title Email

Phone Ext. Fax

PART INFORMATION

Part Name/Number Substrate Material

Briefly describe the part and what is used for:

Present coating

What is the problem with the present coating that needs to be solved?

Describe the environmental and operating conditions (chemicals, abrasives, Temperature, etc.)

COATING CHARACTERISTICS REQUIRED

RATE YOUR COATING CHARACTERISTICS

1=HIGHLY IMPORTANT
8=LEAST IMPORTANT

1 2 3 4 5 6 7 8 NONSTICK
1 2 3 4 5 6 7 8 EASY CLEANUP
1 2 3 4 5 6 7 8 NOISE REDUCTION
1 2 3 4 5 6 7 8 FRICTION REDUCTION
1 2 3 4 5 6 7 8 ABRASION RESISTANCE
1 2 3 4 5 6 7 8 ELECTRICAL SHIELDING
1 2 3 4 5 6 7 8 CORROSION RESISTANCE
1 2 3 4 5 6 7 8 ELECTRICAL CONDUCTIVITY

PRODUCTION FIGURES

Yearly production 25-50 50-100 100-300 500-1000 2500-5000 10K-25K 50K+

Lot sizes
Completion date required

Preferred job start date ASAP 0-30 days 31-90 days 90+ days

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