Apex Medical Technologies, Inc. - Prototying Quote Request Form

Quote Request Form

Please complete the form to the right and we will follow up with you directly. Please contact us if you have any questions.

*Note: Please do not submit any information that is proprietary and/or confidential in nature. We will be happy to sign a Confidentiality Agreement before discussing project specifications.

Please Describe Your Application Below

Required Fields *

1) Describe the functionality of the part or product: *

2) Describe material property/functional requirements:

3) Please select the materials in which you are interested:

	HT-1	HT-3	HT-4	HT-7	HT-8	HT-9	unsure
Thermoplastic Polyurethane

	HT-200	HT-310	HT-311	HT-315	HT-360	unsure
Synthetic Polyisoprene

	HT-1002	HT-1020	unsure
Silicone

Other

3) Desired Material Properties:

Tensile Strength (psi):
Elongation (%):
100% Modulus (psi):
Tensile Set (%):

4) Part Dimensional Requirements:

Length ("):
Diameter ("):
Thickness ("):

If the part has a profile or is shaped, please describe it or supply a drawing:

5) What prototype sample quantities are needed?

6) Will tooling be supplied? If not, a tooling charge will be included in your quote.

Yes

Name:		*
Title:
Company:		*
Address:
City, State, Zip:		*
Country:
Phone:		*
Fax:
E-mail:		*