Oval Single Lumen 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]
Qty Reel(s)         Length on Reel each 
——— OR ———
Qty of cut Pieces Piece Length
PART FOUR - PRODUCT SPECIFICATION
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Oval Single Lumen Extrusion

ID Min
OD Min
ID Max
OD Max
Walls
Concentricity Greater than or eqaul to %
Comments 
You will receive a cost quotation via email within 24-36 hours or less.