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Extrusion Request Form
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Extrusion Request Form
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Extrusion Request Form
To receive a quote for custom extrusion, please fill out the form below. Be sure to click the "Submit Request" button at the bottom of the page when finished.
Tubing Specifications
Tubing Material:
Select One
PET
Nylon
Pebax
High Density Polyethylene
Low Density Polyethylene
Linear Low Density Polyethylene
Hytrel
Polyolefin
Polyurethane
Polypropylene
EVA
Polycarbonate
PVDF
Blended
Other (specify)
Material Grade:
Tubing Requirements
Tubing Design:
Select One
Single Lumen
Multilumen
Striping
Multilayer
Bump
LeadBlended
Other (specify)
Select Number of Lumens
2
3
4
5
More (specify)
Select Number of Stripes
1
2
3
Select Number of Layers
2
3
Inner Diameter:
±
mm
inches
Outer Diameter:
±
mm
inches
Minimum Wall Thickness:
±
mm
inches
Length:
m
feet
Custom Profile or Shape Required:
Yes
No
Explain Here:
Fillers Required:
Yes
No
Select One
Barium Sulfate
Bismuth Subcarbonate
Bismuth Trioxide
Tungsten
Bismuth Oxychloride
Other (specify)
%
Color Required:
Yes
No
Color/Pantone # 1
Color/Pantone # 2
Color/Pantone # 3
Attach Drawing (if available)
Commercial
Quantity:
m
feet
pieces
Date Required:
Production:
Quickturn:
R&D:
Notes/Comments:
Contact Information
First Name:
Last Name:
Title:
Company:
Telephone:
Email:
Address 1:
Address 2:
City:
State:
Zip:
Country:
Fax: