| Contact Name: |
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| E-Mail: |
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| Company: |
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| Street Address: |
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| City, State, Zip: | ,
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| Phone: |
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| Machinery/Application Method |
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A. Machine manufacturer and model number: |
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| B. Application Method: | If Other:
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| C. Application (i.e., case seal, wood assembly): |
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| D. Current operating speed: | units/minute
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| E. Desired operating speed: | units/minute
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| F. Compression cycle: | seconds
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| G. Compression pressure: |
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| H. Type of adhesive being used: |
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I. Pot temperature:
(if hot melt) | oF
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| J. Current adhesive supplier: |
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| K. Product name/number: |
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| Substrate(s) |
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A. What is being bonded? |
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| B. With: |
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C. Are either of the substrates coated?
(yes,no) |
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| D. What type of coating? |
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| E. Other pertinent characteristics of the substrate: |
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| End Use Requirement |
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A. Indicate continuous or intermittent: |
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| B. Temperature extremes: | HighoF, LowoF
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| C. Bond strength needed: |
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| D. Resistance to: | If Other:
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E. Other standards:
(specific test and limits) |
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| Cost |
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A. Current price: | per(pound, gallon, drum, pail)
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| B. Container size: |
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| C. Units bonded per container: |
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| D. Monthly volume: |
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| E. Purchase frequency: |
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| F. Adhesive manufacturing location: |
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| G. Shipping charges/FOB points: |
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| Plant Conditions |
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A. Ambient temperature: | oF, Summer.oF, Winter.
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| B. Humidity: | |
C. General conditions:
(clean, dusty, wet, dry) |
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| D. Other relevant factors: |
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