| Company* |
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Department
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| Contact: |
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| First Name* |
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| Last Name* |
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| Street Address* |
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| City* |
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| State or Province* |
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| Country: |
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| Zip/Postal Code* |
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| Phone* |
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| Fax |
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| E-mail* |
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| Company Web Site Address |
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| Which mold release system would you prefer?* |
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| What mold release product are you currently using?* |
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| Product Number/Ref: |
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| How is your current mold release applied?* |
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| If "other," explain: |
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| What is your Primary Market?* |
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| What is your manufacturing process?* |
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| If "other," explain: |
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| Size of part?* |
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| What materials/resins are used?* |
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| Is Gel-Coat used?* |
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| Mold surface is made of:?* |
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| What is your mold temperature during ... |
| (a) Mold release application? |
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| (b) Part cure (peak)? |
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| In order to answer your questions accurately, please explain the details of your mold process and what problems you would like to correct. |
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| Thank you. |
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