Name: | * | Gender: | malefemale |
Position: | Tel: | * | |
Fax: | E-mail: | * | |
Company: | * | Website: | |
Address: | |||
City: | * | Zip: |
The adhesive you are currently using: | |
Please briefly describe the properties that your current adhesive(s) lack: | |
Substrate: | |
End-use of the product: | |
Number of parts needed to be bonded per day: | |
Bondline size: | |
Expected curing time: | |
Application conditions: | Extreme temperatures Outdoors High humidity Contact with chemicals Other conditions |
Specify the above “Other conditions”: | |
Will you consider using two-component adhesive: | YesNo |
How to use the adhesive: | |
The work time you expect (minutes): | |
When will you need the adhesive: | |
Do you need dispensing equipment: | YesNo |
What service(s) do you need: | SamplesOn-site demonstrationProduct literatureContact information |
Additional information: | |
Code: | |