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Product Description *Size

OD		ID
Other
Wire:
OD		Other
Applications

Width	Height	Other
Substrate
Width	Height	Other

Single Layer Material
Multiple Layer Material
1		2
3		4
5
Layer Wall Dimension
1		2
3		4
5
# of Stripes
Stripe Material

Extruder

Brand Name
Size:		Age:

Extruder

Crosshead

In-line Head

Both

Operator Experience:

Experience

Skill

Name *	Email *
Company
Address 1	Address 2
City	State
Country	Zip
Phone	Fax

Other Information

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Seal

1

Seal

Composite

1
2
3

Composite

Multiple Layer Material

1
2

Multiple Layer Material

Crossheads

1
2

Crossheads

In-Line Head

1

In-Line Head

Both

1

Both

Crossheads

In-line Heads
- Solid
- Tube
- Hose
- Pipe
- Profile