*First Name: 

*Last Name: 

*Division: Please select one... Dyneon EAMD Other

*Email Address: 

*Confirm Email: 

*Telephone Number: 

Compound Formulation Details

*Compound Type: Please select one... PTFE Thermoplastic

*Polymer: 

Additives & Fillers (Specified By Weight)

*1. 

2. 

3. 

4. 

All compound components must be specified. Any request calling for generic components (ie. polypropylene, green, 20% glass) cannot be quoted.

*Specific Property Targets and QC Requirements:

*Customer Name: 

*Fabrication Process: Please select one... Extrusion Injection Molding Other

*Initial Sample Size Requested:  (Maximum sample size is 50 lbs.)

*Date Sample is Required:  (There is a nominal charge for samples.)

*Potential Annual Volume: 

*Scale Up Date: