Contact a Product Specialist

If you prefer to fax us your request, please click here for a printable Adobe PDF version of this questionnaire, and fax your questionnaire to (770) 261-4805.

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Personal Information

Name (First / Last)*
Company *
Market *
Job Function *
Email*
Phone *	ext.
Address *
City *
State	Zip/Postal *
Country *

Specific Information

P.O. :
OEM Industry :
P/N :
Qty (U/M) :
Base Mat’l & Hardness :
Cure Restriction :
Operating Temp :
Motion :
Corrosion Requirement :
Coating Process Thickness :
Requirement Range :
Charge :

Requested by :
Return to :
Load/Speed :
Part Name :
Annualized Volume :
Mating Mat’l & hardness :
Current/tested finishes :
Customer Spec :
Testing Criteria :
Liquid Compatibility :
Drawing :
Revision :

Your Problem

1. Please identify the primary problem, e.g. galling, fretting, wear, corrosion, etc :	2. Define what is considered part(s) failure :


3. Visually describe the problem or failure condition of the part(s) :	4. Will blueprints and parts be available for coating selection and submittals?

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