Precision - Sample Request Form

Sample Request Form,

Request for Samples
Name		Company Name
Title		Company Address
Phone
FAX		E-mail
How did you come to our website? search referral advertisement other:
Type of tube: single lumen multi-lumen braided stripe coextrusion other:
Application
General samples required: misc multi-lumen other:
Or specific size: OD: ID: WALL: inch mm
Material: other: Grade or Hardness (if known): Shore A Shore D
R/O filler: no yes, specify: other: Quantity or length:
Properties of material (if material not specified above)		other:
Material (inner layer or stripe): other: Grade or Hardness (if known): Shore A Shore D R/O Filler: yes no
Braiding material
Other

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Request for Quote

Information / Contact Request

12 Glens Falls Technical Park
Glens Falls, NY 12801
Phone: (518) 792-1199
FAX: (518) 792-3805
Email: sales@precisionextrusion.com