Application Profile - Medical
Company Name
Name
First Name
Last Name
Designation
Department
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Address
Street Address
City
State / Province
Postal / Zip Code
How did you hear about us?
Existing Customer
Newsletter
Referral
Search Engine
Is this a new project?
Yes
No
What is the current chemistry (if any)
Acrylic UV
Activator Cure
Cyanoacrylate
Epoxy
Hot Melt
Silicone
Urethane
Other
TDS (if available)
Browse Files
Cancel
of
MSDS (if available)
Browse Files
Cancel
of
Drawing/Image (if any)
Why do you want to change the current product?
Cost
EOL
Process
Product
Quality Concerns
End product
eg. Needle, Catheter etc.
Substrate
Please list specific materials used e.g. ABS, PVC etc.
Shadowed areas?
Yes
No
Not sure
What is monthly production volume?
How do you plan to dispense the proposed material?
Manual
Automation
Adhesive Requirements
Rows
Please provide as much information as possible
A. Viscosity (cps)
B.
Hardness / Flexibility
C.
Clarity
D.
Fluoresce
E. Thermal Limit
F. Moisture Resistance
G. USP Class VI
H. ISO Class
I. Other
Product Testing
Rows
Please provide as much information as possible
A. Adhesion
B.
Autoclave
C.
Aging Test
D. ETO
E. Humidity
F. Moisture
G. Solvent Resistance
H. Other
Any testing conducted on finished assemblies? If yes, please elaborate
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