BRYANT RUBBER REQUEST FOR QUOTATION
Contact Information
* Indicates required fields * Company Name: * Address: * City: * State: * Zipcode: * Contact Name: * Phone: * Fax: * E-Mail:
* Indicates required fields
* Company Name:
* Address:
* City:
* State:
* Zipcode:
* Contact Name:
* Phone:
* Fax:
* E-Mail:
General Information
1) Description of Product Program:
2) Brief description of product function:
3) Life of program (yrs):
4) Electronic drawing available? Yes | No If yes, attach electronic drawings or specifications here: A: B: C: D: E:
5) Estimated annual usage: Year 1: Year 2: Year 3:
6) Price target:
Material and Functional Requirements
7) Material description:
8) Durometer:
9) Color:
10) Specification / ASTM callout:
11) Is this application Industrial or Healthcare? Industrial Healthcare
12) Environmental considerations:
13) Operating temperatures:
14) Is this application static or dynamic? Static? Dynamic?
15) Is this product exposed to fluids? Yes | No If yes, what kind?
16) Is this product exposed to gases? Yes | No If yes, what kind?
17) Is sterilization required? Yes | No If yes, what kind?
18) Is this product exposed to extreme vibration? Yes | No
19) Are there special packaging requirements? Yes | No If yes, what are they?
20) Is any special testing required? Yes | No If yes, what kind?
21) Remarks:
...or clear this form.