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    Date

    Company Name :

    Contact Name :

    Street Address :

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    City :

    Part Name :

    Primary Purpose :

    Item Weight (g) :

    Material, (type of plastic) :

    Colour :

    Annual quantity :

    Is CAD model available?

    Is drawing available?

    Is a sample available?

    Is flame retardency required?

    Is UV stabilization required?

    Is food contact required?

    Is tooling ( mould ) available?

    Is a hot runner system required?

    Is post moulding work required?

    Phone Number :

    Facsimile Number :

    Email :

    State :

    Postcode :

    Part Length (mm) :

    Part Width (mm) :

    Part Height (mm) :

    Wall Section (mm) :

    Finish ( e.g. polished, matt, grain.) :

    Order quantity :

    CAD File Format :

    Indicate gate position :

    Cycle Time (s) :

    If so, how many cavities :

    If so, number of gates ( e.g. drilling, welding, printing, assembly ):

    If so, type of work :

    Packaging Details :

    Additional comments :

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