|
*Denotes
required fields
|
|
Contact Information
|
|
*Name
|
|
|
*Company
|
|
|
*Street
|
|
|
*City
|
|
|
*State
|
|
*Zip
|
|
|
*Phone
|
|
Fax
|
|
|
*E-mail
|
|
| |
| Part
Information |
| Part Number |
|
| Description,
Application or Function of Part* |
|
|
|
| Material* |
|
| Durometer |
|
| Color* |
|
| Can An
Alternative Material Be Used? Yes
No |
| Application
Temperature & Environment |
|
|
| This is a* New
Application Redesign
Existing Part |
|
This is a Component
Supply Item
|
|
|
Quantities / Usage
|
|
Estimate Annual Usage*
|
|
| Quantity per
Shipment |
|
|
Frequency of Shipments
|
(once a week, once a month, etc.)
|
|
Requested Initial Ship Date
|
|
|
|
Quality / Inspection
|
|
Level of Quality Reporting Required:
|
| PPAP Required Yes
No |
If so, What
Level? 1 2
3 |
|
Are There Critical Dimensions?
|
Yes
No
|
|
Is Flash Allowed?
|
Yes
No
|
| Is Parting
Line Defined? |
Yes
No |
|
Is A Special Mold Finish Required?
|
Yes
No
|
|
Is Engraving or Special ID Required?
|
Yes
No
|
| Is Special Packaging Required? |
Yes
No |
|
|
|
Prototype
|
| Is a Prototype
Required? |
Yes
No |
|
Prototype to be used as?
|
Product Proof Concept
|
|
|
| Drawing |
|
Attach Drawing Now*
|
Yes
No
|
|
Drawing to be sent by email under separate
cover?*
|
Yes
No
|
|
Drawing to be faxed?*
|
Yes
No
|
|
|
