Company Name:
*Contact Person Name:
*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
(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
            (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
Other Testing
Is there any testing conducted on finished assemblies? If yes, please elaborate.
ADE Proposal and Comment: