Application Development Inquiry Form

Application Development Inquiry

Type:
Contact Information:
Name:
Title:
Company:
Address:
Suite:
City:
State:
Zip Code:
Phone:
FAX:
Email:

Describe the application (include a product name):


Is this a new or existing product?


Describe the physical environment the product will be exposed to:


Does this application need to meet any special requirements? Check all that apply:
Flame Retardant
Static Resistance
Low Temperature
UV Resistance
Low Smoke
Other

Do you have specific certification requirements? (i.e. UL 94VO):


Will the part be subjected to any additional internal or external tests (i.e. drop tests, impact, wear, etc.)? If yes, please describe:


Who is the OEM? (optional)


What is the time frame for the project?


What color is the part?


Estimated volume for:
Year 1:
Year 3:
Year 5:

Do you have specific target physical properties? Fill all that apply:
Tensile Strength (psi)
Izod Impact, notched
Flexural Strength (psi)

Questions/Comments:

� 2005 Ebbtide Polymers Corporation PO Box 682445 Franklin, TN 37068-2445
Phone: 888-215-3143 Fax: 888-215-3143