Consultation Request Form

Complete the form below to Schedule a free consultation. Providing as much information as possible will allow us to verify that the product selected is going to provide you with the best solution. A Dymax Representative will contact you upon completion of the form.

Fields marked with an (*) are required.


Contact Information

General Contact Information
*Salutation:
*First Name:
*Last Name:
*Title:
*Company:
*Address:
 
*City:
*State/Province:
*Postal Code:
*Country:
*Phone:
Fax:
*Email:
 

Application Information

Are you currently working with a Dymax Sales Partner?  
*If "Yes" who?


*End item to be manufactured with Dymax product (examples: catheter, turbine blade, cell phone, etc.):

*Describe the application (description & purpose of material):

*Substrates to be bonded or coated (list any coatings and list specific plastics):


Shadowed Areas:  

Current Method

Current Product Name:

Proposed Process

How many parts will you manufacture per hour?  

How do you plan to dispense and cure the proposed material?

Do you have a UV light source?  
*If yes, what kind?

Adhesive Requirements

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

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

Additional comments or requirements:

Want to know about the latest Dymax products and news? Opt-in to receive our bimonthly Light Lines newsletter. You can opt-out anytime. View samples.
Yes, please!
No, thanks.

Security Code: Enter the code shown below (this helps us prevent spam)
Verify


Privacy Policy: We value your interest in the Dymax website and hope you'll return often, seeking solutions for your bonding and coating challenges. Because of this, we consider your contact information and any other information that you provide us as confidential. This means, most importantly, that we do not sell your contact information to anyone. Instead, your information is used by us solely to provide you with the information and assistance you have requested. View our complete privacy policy.