Company Name:
*Contact Person Name:
*Email:
*Tel No:
How do you get to know about us? (Website, referral, etc):

* Compulsory fields.

1. Describe the End product name?
    End product name:
(e.g.: Needle, Catheter, Respiratory and etc)
2. Application Information
    A.Substrate:
(List Specific Plastic e.g. ABS, PVC and etc)
    B.Shadowed Areas? : Yes No Not Sure
3. What is the expected monthly production volume?
    
4. Is it a new project? Yes No
    A. What is the current chemistry?
     CA Urethane Epoxy Acrylic UV Activator Cure Acryl Hot Melt Silicone
    Other:
            (Attach material specification e.g. PDS, TDS, PS, TI)
5. How do you plan to dispense and cure on the proposed material?
     Manual Automation
6. Adhesive Requirements:
A  Viscosity (cps)
B  Hardness / Flexibility
C  Clarity
D  Fluoresce
E  See Cure Technology
F  Thermal Limit
G  Moisture Resistance
H  USP Class VI
I  ISO Class
Other Adhesive Requirement
7. Product testing:
A  Adhesion
B  Autoclave
C Moisture / Humidity / Solvent resistance
D  ETO
Other Testing
Is there any testing conducted on finished assemblies? If yes, please elaborate.
ADE Proposal and Comment: