| Name: |
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| Title: |
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| Company: |
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| Address: |
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| City: |
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| State/Province: |
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| Country: |
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| Zip Post Code: |
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| Phone: |
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| Fax # : |
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| Email : |
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| 1. Describe product to be treated: |
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| 2. Material product is made: |
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| 3. Indicate surface(s) to receive coating treatment: |
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| 4. Do you require? |
Water-clear option |
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Anti-fog option |
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| Anti-glare option |
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Anti-static option |
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5. If abrasion resistance is primary feature, please describe use conditions where abrasion is encountered:
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6. If chemical resistance is primary feature, please specify chemicals and conditions encountered: |
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7. If anti-fog is primary feature, describe use conditions (humidity, heat, etc): |
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8. If anti-static is required, specify use conditions: |
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9. Specify product’s use/environment, i.e. indoor, outdoor, temperature range, humidity: |
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10. Other product requirements:
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ASTM
MIL-STD
Other
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11. How will your product be supplied to PCI for coating treatment, i.e., packaging, traying? |
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12. Estimated quantities required and usage? |
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| 13. Is your application for |
current
or future planning?
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