Oligomer Samples Request

Request an OLIGOMER SAMPLE

Please provide as much information as possible. This will allow us to verify that the product selected is going to provide you with the best solution.

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:

Ship to Information
Please complete if different than contact information
*Salutation:
*First Name:
*Last Name:
*Title:
*Company:
*Address:
 
*City:
*State/Province:
*Postal Code:
*Country:
*Phone:
Fax:
*Email:
Application Information

*How did you hear about Bomar™ products?   


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


*Shipping Carrier:
*Account Number:


*End item to be manufactured with Bomar product :

*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:

Current Chemistry:

If "Other" or "None" Please Specify:
Proposed Process

Potential Volume?  

How do you plan to cure the proposed material?

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

*Physical Properties (viscosity, hardness/flexibility, color, clarity, etc.):

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

Additional comments or requirements:

Product(s) selected:


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