Client Company:
Street Address:
Summary of Application
(include materials used, current method, adhesive, reason for change, etc.) 

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What problem(s) are we solving 
(if more than 1 rank them 1, 2, 3, etc.)?
Curing Options 
(1 or 2 part, UV curing, fixture & mixture life times, time in station and 
stations available to cure and dispense):
Uncured Requirements
(Viscosity, color, odor, etc)
Cured Material Requirements
(strengths, Temperature, Color if applicable, Other Environmental conditions):
Pricing Requirements (or target cost per part with volume/part):
Miscellaneous Requirements Not Covered Above:



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