Your Name

    Your Job Title / Position

    Your Telephone Number

    Your Email

    Company Name


    City, State & Zip

    Required Delivery / Due Date

    Inquiry or Reference#

    Is this a New Part, for Prototype or Production:

    If prototype, what is production quantity range?

    Is a budget in place and approved for this project?


    Is this an existing part, modification or are you seeking a new vendor?


    Existing Tool Available?

    Type of Tool

    If not available, is there a budget in place to replace the tool?

    If you are seeking a new supplier, how committed are YOU to connecting to US?


    If less than 10, what stands in the way?

    Are you a manufacturer?

    What is your target price?

    Who is the Engineer assigned to this project?

    When will decision to move ahead be made?

    Beside yourself, who else will be involved in the decision?

    What are your product dimensions?

    What Specification does your material need to meet?

    Color preference

    Density / Durometer

    What quantity are you looking for?

    Additional Comments

    Upload drawing if available (not required)

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