Performance Urethane
Request Form.


 
 
Request Form:

 
First Name
Last Name
Company Name
Your Title
Address
City
Prov / State
Postal code / Zip Code
Telephone #  Area   Number 
Fax # Area   Number 
E-Mail

 
Properties Required
Check all that apply.

Abrasion Resistance
Cold Temperatures
Compression
Elongation
Flex
Impact Resistance
Machinabillity
Resilience / Rebound
Tensile
Other

Required Working Limits


Minimum Load
Maximum Load
Velocity
Temperature Range
UV Exposure
Submerged
Chemicals in contact
Bonded to steel, aluminum, or other
Other details 

 
 

OCCUPATION:



Sales/Marketing
Legal/Accounting
Education
Medical/Health Care
Mechanical/Construction
Self Employed
Service Industry
Information Services
Clerical/Administration
Management
Other      Other 

 
 
 
How Did You Hear About Performance Urethane ?



Friend/Referral
Internet Search
E-mail
Print Advertising
Business Advertising
Sign Up Event
Other           Other 

 

Description, application, dimensions
or additional information required:

HAS YOUR INFORMATION BEEN ENTERED CORRECTLY?


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