Customer Information:

Date Prepared:
Company Name:
Address (1):
 Address (2):
City & State:
     Zip:
Contact Person:
 Title:
 Email:
 Phone:
     FAX:


    ___________________________________________________________________________________________________

Development Information:

EXISTING PART:
NEW PART:
 Other:
If Other Explain:
Customer's Part #:
   Part Name:
UPC Part #:
Type of Extrusion:  Rigid: Flexible:     Dual Durometer:
Rigid Polymer:
Rigid Color:
Flexible Polymer:
 Flexible Color:
    Length:
   Tolerance:
Package:
Misc. Information: