Place Order

Please fill out the form provided with as much information as possible. Once you have provided this information, please press "Email this Form" to submit your order via email or press "Print & Fax this Form" to print the form and fax it to: 810-364-4878.

If you have any questions about the information asked for, please give us a call at 810.364.4877

Customer:
Contact:
Email:
P.O. No.:
   
Phone:
Requested Run Date:
Job No.:
Does Customer request to be present for run? Yes   No
Mold Information
 (Please check all applicable boxes and answer all applicable fields.)
Prototype Run New Tool Sample Short Run First Run Eng Chg
Re-Run Color Change Dimensional Functional Cosmetic
Material Change Other      
 
Press Size Requested:
85 Ton (Tie bar spacing 16" x 13.6" x Max Ht 16"/Min Ht 4" with 3" Max Ejection)
230 Ton (Tie bar spacing 22" x 22" x Max Ht 22"/Min Ht 7" with 4.5" Max Ejection)
400 Ton (Tie bar spacing 28" x 28" x Max Ht 28"/Min Ht 8" with 6.0" Max Ejection)
 
Mold Dimensions:
 (L):   (W):   (H):
Part Number:
Part Name:
Number of Cavities:
Qty Requested:
Material Type/Color:
Drying Required:
 Yes No
Hand loads/Inserts:
 Yes No
No. of Inserts:  
Hot Sprue:
 Yes No
Offset Sprue:  
 Yes No
Core Pull Required:
 Yes No
Threaded Knockout:
 Yes No
Hot Runner: 
 Yes No
Type:
# of Zones:
Water/Oil Fittings:
200 Series    300 Series     Other:
Additional Comments
OR
Please Sign and Date this Application:

 

Authorizing Signature:________________________________________  

 

 

Date:_____________________________

 

 

 

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