Information Request

Company Name:
First Name:
Last Name:
Job Title:
Mail Stop or Department:
Mailing Address:
City:
State/Territory:
Postal Code:
Country:
Phone:
Fax:
Email Address:
Your Company Website:

	Gasketing for Water Sealing		Shock / Vibration Dampening
	Gasketing for Dust Sealing		Thermal Management
	ESD / EMI		Other:

Location

Indoor

Outdoor

Temperature

Temperature Range: °F to °F

Temperature Range: °C to °C

Water Exposure

Light exposure to water (rain or light spray)

Heavy exposure to water (heavy rain or hosedown)

Submerged in water

Flame

UL 94 Flame rating is required

Other flame rating is required (specify):

Would you prefer a peel and stick adhesive backing?    Yes   No

If so, what type of substrate is to be bonded to (e.g., steel, plastic, powder coated metal,      painted metal, etc.)?

If known, what is the thickness requirement for the material?  inches   or  mm

Is there a CAD file available that may be used to cut sample parts?    Yes   No