Custom Color Matching Form
The following fields are required for a customer intake form at Dynamic Modifiers, LLC
Company Name
*
Contact: Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
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Aruba
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Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
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Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
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China
Christmas Island
Cocos (Keeling) Islands
Colombia
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Cote d'Ivoire
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Cuba
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Democratic Republic of the Congo
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Djibouti
Dominica
Dominican Republic
Ecuador
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Equatorial Guinea
Eritrea
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Ethiopia
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Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
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Guinea
Guinea-Bissau
Guyana
Haiti
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Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
TYPE OF PROJECT (Only select the type that is applicable)
Color Target (How is the target being submitted?)
Please Select
Physical chip
Pantone #
Existing part sample
Material
Please Select
Physical chip
Pantone #
Existing part sample
Customer Color Match to Quote Custom Color
Please Select
Carrier resin: PP
Carrier resin: PE
Carrier resin: LLDPE
Carrier resin: HDPE
Specific resin grade
MFI
Are you using virgin or recycled/regrind content?If yes, what (% if known) Note: If you are using recycled resin, we should be provided a 20 lb sample of it so that the color match is exact after you combine it with your recycled resin.List any additives already in the resin (UV, FR, fillers, etc.)
Process type: injection molding / extrusion / blow molding / film / rotomolding / other Processing temperature range Concentrate loading % Concentrate dosage rate
Application
Please Select
Indoor
Outdoor
End-use application (be specific) Any compliance requirement: FDA/food-contact, UL, automotive spec, other
Is this a new part number or a rematch of an existing color? Quantity needed at 300 lbs, or more? (note: pricing/availability may change above 300 lbs) Estimated annual volume if this moves to production.
Upload the spec sheet or any additional info
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Check that you understand that all 24-hour custom color matching is contingent on being a client of Dynamic Modifiers. An order of at least $1,500 will be invoiced when the custom color matching is completed for a minimum order of the product.
I understand and agree.
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