In order to assist you better with your coating applications, please fill out the following questionnaire.

Name: Email Address:	Company: Phone:
1. What exactly do you expect the coating to do? 2. Please describe your application:

Name of Part:
Function:
End Use:
Total Area To Be Coated:
Estimated Quantity:

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3. Please rate the importance of the following properties of the coating for your application:

1 = Very Important

2 = Somewhat Important

3 = Not Important

	Non-stick/Release		Low friction/Dry lubricant
	Abrasion resistance		Chemical resistance
	Electrical insulation		Heat resistance
	Other (Please specify):

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4. Please describe the service conditions that the coating must withstand:

	Temperature		Minimum		Normal		Maximum
	Chemicals (Specify)
	Load (psi)
	Abrasives
	Outdoor Exposure

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5. Has the part been coated before?

Yes

No

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6. If so, please explain the type of coating tried and the best results.

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7. Other comments:

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