Information
Company:
Address:
City:
State:
Zip Code:
Phone Number:
Fax Number:
Email Address:
Date:
Date Needed:
Job No.
Material:
Preferred Rod:
Pieces
Number of Pieces
Sprue Brush
Manifold
Die
Punch
Cavity
Core
Base
Insert
Slide
Lifter
Other
Types
NEED
Hard
Soft
WILL BE
Color Match.
High Polish
Textured
Chromed or Nickled
Has been H.T.
Has not been H.T.
Will not be H.T.
Will be H.T
TEXTURE
Chemical
Media Blast
EDM Finish
NITRIDE
Ion Gas
Liquid
Submit File:
