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Customer
Name_________________________________________
Address___________________________________________________
City_________________________________
State__________
Zip_____________
Contact _______________________________
Co.
Title__________________________
Phone (_____)________________
Email_____________________________________
Company Web
Site________________________________________________________
Company Size-# Employees _________
Gross Annual Sales
$____________________
What Market does your Company Sells to ?
(i.e. Medical, Automotive, Electronics,
Computer, Packaging, etc.)
______________________________________________________________________
Project Information
Part Description
__________________________________________________________
Part Number
_______________________________
Rev. Level_______________
Project Name
____________________________________________________________
End Use Application
______________________________________________________
Part Material
____________________________________________________________
Part / Material Colors 1. ______________
2. _________________
3. _______________
Cosmetic Requirements
____________________________________________________
Texture Requirements
______________________________________________________
Quality Expectations /
Requirements___________________________________________
_____________________________________________________________________
Estimated Annual Usage__________________
Estimated Project Life-Years___________
Production Quantities to
Quote______________________________________________
Are there UL, UV, FDA, NSF, etc.
Requirements ?
Yes ______
No ______
Are there Packaging / Labeling /
or Part Marking Requirements?
Yes _____
No _____
Are there any Secondary Requirements such
as: Highlighting, Airbrushing, Screen
Printing,
Vinyl Graphics, Light Assembly, Etc. ?
______________________________________________________________________
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