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Providing as much information as possible will allow us to verify that the product selected is going to provide you with the best solution.

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Contact Information
*Contact:

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Best day/time for you to be contacted:

Application Information
How did you hear about DYMAX?
Are you currently working with an authorized SPEEDMASK^® Sales Partner? Yes No *If "Yes" who?
*End item to be protected with DYMAX product (examples: turbine component, orthopedic implant, surgical instrument, etc.):
*Describe the surface treatment or enhancement application (include duration cycle, temperature of solutions, or heat exposure):
*Substrates to be masked (identify if surface is coated or uncoated):
Shadowed Areas: Yes No Not Sure

Current Method
Current Product Name:

Proposed Process
How many parts will you manufacture per hour?
Manufacturing Process: Manual Automated
How do you plan to dispense and cure the proposed material?
Do you have a UV light source? Yes No *If yes, what kind?

Masking Requirements

Physical Properties (viscosity, hardness/flexibility, color, clarity, or fluorescense needed):

How do you plan to test the proposed material? (adhesion, thermal, moisture/humidity):

Additional comments or requirements:

Product(s) selected:

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DYMAX Corporation 318 Industrial Lane