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
*First Name:
*Last Name:
*Postal Code:

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:

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