P.O. Box 80307
Fort Wayne, IN 46898-0307
Ph:  (260) 489-0728 or (260) 489-0825  or 1-800-325-7040
Fax: (260) 489-0519

Technical Survey Form

First Name Last Name
E-mail Address
City State/Prov.
Zip/Postal Country
Telephone Fax
 
Application:
Substrates involved (submit examples if possible):
End Product manufactured:
Preferred assembly process:
Problems Encountered:

Environment

Temperature Extremes (min. & Max.):
Continuously:
Intermittently:
Chemical or solvents involved:
Other (Weather, sunlight, etc.):

Special Requirements

Specifications to be met (mil. etc.):
FDA/USDA regulations:
Color:

Application Requirements
Machine Application or hand application:
Can primer be used? Yes No
Parts should be ready for handling after how many hours
Maximum cure time:
Current Product used:
Estimated monthly requirements:
Are you willing to switch, use, or test another product?:
 

  Major considerations:

 
$:
Quality:
Availability:
Other Comments/Questions/Suggestions:
 
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