Contact a Product Specialist Directly

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.


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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