Application Recommendation Info sheet
Customer Name :   Date :
Company Name :   City :
Address :   Zip Code :
State :   Phone :
Country :   Fax :
Email :  
1) State problem and tell us what the customer wants to accomplish :
2) Which material or process is now being used which is failing or unsatisfactory? Explain
3) Application Environment :

Online :
Ambient temp :
Wet/moist :
Immersed :
4) Base Material (S) :

Bond
Coat
Pot
Seal
5)Temp. Range :

Continuous
Intermittent
6)Thermal Shock : Yes No
7) Chemical Exposure :

Immersion
Vapor
Continuous
Intermittent
8) Mechanical Loading :
Shear
Tensile
Compression
9) Desired Viscosity (Liquid,Paste) : 10) Curing (Yes/No) :
11) One/Two Component : 12) Estimated Area :
13) Price Constraints : 14) Estimated volume :
15) Please email or fax any sketches available.
16) Comments: