Mono Filament Fiber Extrusion Request Form
PART ONE - ORDER INFORMATION
Date       Phone      
First Name      Last Name
Company / Address      Street       
Address     State      Zip      Country
Product Application
Request Category Best Effort      Development      Trial      Production      OQ / PQ      Validation     
Purchase Order #   Reference Document(s)
PART TWO - MATERIAL DESCRIPTION
WT%
POLYMER TYPE
TRADE NAME
GRADE NUMBER
ADDITIVE / COLORANT
%
%
%
%
PART THREE - PACKAGING
Final Quantity
[Select One Only]
 Spool(s) with each 
——— OR ———
Weight
PART FOUR - PRODUCT SPECIFICATION

Mono Filament Fiber Extrusion
 Diameter
Maximum Ovality Less than or equal to
Comments 
You will receive a cost quotation via email within 24-36 hours or less.