Request for Quotation

Company *		Request Date
Address *		Need Proposal By
City *		State * Zip: *
Contact *		Title
Phone *		Fax
Email *
Expected Purchase Decision Date

Material Specs

Material Type Single Component   Plural Component

Formulator Product Name

Type Urethane   Silicone Acrylic   Lubricant Other Type

Application Bonding   Potting   Molding   Sealing Coating   Lubricating Gasketing Other Application

Type of Flow Continuous   Shot Bead

Material Properties

	AComponent	BComponent
Nomenclature
Mixing ratio by volume
Mixing ratio by weight
Specific Gravity	A B Mixed
Viscosity cps @ 25°C (77°F)	A B Mixed
Viscosity at working temperature
Pot Life	Mins Hrs Mass Degrees C F
Is material filled
If yes what type
Is it abrasive
Does it need agitation
Is Degasification required
Is it thixotropic
Is it corrosive
Is it moisture sensitive
Original container size
Average daily usage mixed

Application Requirements

Metered shot size	ccs	grams	fl ozs	Other
Shot size tolerance
Bead size	Diameter	Length
Flow rate	ccs sec	ccs min	lbs min	Other gal min
Production rate	parts min	hour	Other gal/min
Time allowed to dispense
Time allowed to index
Total cycle time part
No of shifts per day
Electrical requirements	volts	phase	hz

Machine Options

	fixed dispense head mounted on meter mix		Linear Encoded Shot Size Controller
	Remote Dispense Head		Shot Timer
	Remote Host Length ft		Pot Life Auto Shot Control
	Remote Trigger handle for hand held gun		Programmable Controller
	Pressure Tank Supply A B		Rate Controller ie Bead Dispense
	Tank Agitator A B		Metere mix stand
	Tank Low Level Sensor A B		Mobile Cart meter mix tanks or drums)
	Tank High Level Sensor A B		Boom and Load Balancer
	Tank Degassing A B
	Tank Heat A B		Transfer Pump Supply 55 gallon or tote
	55 Gallon Cascade Drum Stand A B		Other

Description of Application