Tell us about you!
HOME ABOUT US CONTACT US PRODUCT LIST	Name:
	Company:
	Address:
	City:
	State/Province:
	Zip Code:
	Country:
	Telephone:
	Fax:
	Email:
	Tell us about your application:
	Application:(Check one)	Open Mold Pour Closed Mold Injection
	Material Type:	Elastomer Foam, Rigid Foam, Flexable Other:
	Product to dispense: (Check one)	Polyurethane Epoxy Silicone Other - Describe:
	Mix Ratio:	By weight: By volume
	Component Viscosity:	Resin or polyol cps @ deg. F. Hardener or iso cps @ deg F.
	Specific Gravity:	Resin or polyol     Hardener or iso
	Fillers: Type (describe):
	Pot Life:	Seconds or, minutes
		Size of mass
		Temperature deg F.
	Processing requirements:
	Heating of components:	Temperature of resin or polyol deg F.
		Temperature of hardener or iso deg F.
	Do components require vacuum degassing?:	Yes No
	Are the components moisture sensitive?:	Yes No
	Size of part to be molded:
	Number of parts to be molded per day:
	Dispense rate required:	Minimum:   lbs/minute Maximum:  lbs/minute
	Ratio of components:	Variable Fixed
	Mixer type:	Dynamic Static
	Agitation of components required?	Resin or Polyol: Yes No Hardiner or Iso: Yes No
	Material Storage:
	Day tanks required?	Resin or polyol: Yes No Size of tank:
		Hardener or iso: Yes No Size of tank:
	Other:	Dispense from drums: Yes No
		Dispense from totes: Yes No
	Automation: Describe your requirements for automation of the dispense equipment or interaction needed with other elements of your production process.
	Please review your information and press the Send Data button to send the data to us.  Press the reset button to clear the form of all data. We will get back to you right away with your quote!