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2 Layer Co-Extrusion Request Form
PART ONE - ORDER INFORMATION |
| Date |
Phone
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| First Name |
Last Name
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| Company / Address |
Street
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| Address State |
Zip
Country |
| Product Application |
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| Request Category |
Best Effort
Development
Trial
Production
OQ / PQ
Validation
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| Purchase Order # |
Reference Document(s)
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PART TWO - MATERIAL DESCRIPTION
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PART THREE - PACKAGING |
Final Quantity
[Select One Only] |
Qty
Reel(s)
Length on
Reel
each |
——— OR ——— |
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Qty of cut Pieces
Piece Length
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PART FOUR - PRODUCT SPECIFICATION
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Two Layer Co-Extrusion |
ID |
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| OD |
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| Wall (W1) |
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| Wall (W2) |
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| Concentricity |
 % |
| Maximum Ovality |
 |
| Comments |
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| You will receive a cost quotation via email within 24-36 hours or less.
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