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New Customer Test Request EcoCortec

for EcoCortec

Today's Date*
dd/mm/yyyy
User E-mail*
Requested By*
- Cortec Sales Manager
- Cortec Distributor
- Laboratory Employee
Name*
First Last
Goal:
Distributor Information
Distributor Name*
First Last
Distributor Company Name*
Address*
Street Address Address Line 2 City ZIP / Postal Code Country
Distributor Information
Distributor Company Name*
Distributor Address*
Street Address Address Line 2 City ZIP / Postal Code Country
Cortec Rep Name*
First Last
End User Information
Name*
First Last
End User Company Name*
Address*
Street Address Address Line 2 City ZIP / Postal Code Country
Sales Potential*
End User Application/ Process Overview*
Test Goal
Required Tests
Required Tests*
- Adhesion - Tape
- Film Mechanical Properties
- Humidity (ASTM D1735 or ASTM D1748)
- Immersion Corrosion Testing
- Oil Compatibility
- Razor Blade Test
- Rubber/Elastomer/ Compatibility
- Vapor Inhibiting Ability (VIA)
- Viscosity
- Other Tests
Please Specify Tests*
End User Information
Name*
First Last
End User Company Name*
Address*
Street Address Address Line 2 City ZIP / Postal Code Country
Sales Potential*
End User Application/ Process Overview*
Test Goal
Required Tests
Required Tests*
- Adhesion (Tape)
- Film Mechanical Properties
- Humidity
- Immersion Corrosion Testing
- Oil Compatibility
- Razor Blade Test
- Rubber/Elastomer/ Compatibility
- Vapor Inhibiting Ability (VIA)
- Viscosity
- Other
Please specify*
Chemical Samples
How many samples?*
Product(s) Information*
- Ready to Use
- Concentrate
- Not Applicable
Recommended Dilution Rate (if applicable)
Attach SDS for each individual liquid*
Drop files here or

Accepted file types: pdf, Max. file size: 64 MB.
Product(s) Information*
- Ready to Use
- Concentrate
- Not Applicable
Recommended Dilution Rate (if applicable)
Attach SDS for each individual liquid*
Drop files here or

Accepted file types: pdf, Max. file size: 64 MB.
Product(s) Information*
- Ready to Use
- Concentrate
- Not Applicable
Recommended Dilution Rate (if applicable)
Attach SDS for each individual liquid*
Drop files here or

Accepted file types: pdf, Max. file size: 64 MB.
Product(s) Information*
- Ready to Use
- Concentrate
- Not Applicable
Recommended Dilution Rate (if applicable)
Attach SDS for each individual liquid*
Drop files here or

Accepted file types: pdf, Max. file size: 64 MB.
Product(s) Information*
- Ready to Use
- Concentrate
- Not Applicable
Recommended Dilution Rate (if applicable)
Attach SDS for each individual liquid*
Drop files here or

Accepted file types: pdf, Max. file size: 64 MB.
Metal Parts/ Non Chemical Samples
Do you have metal parts/ non chemical samples?*
- Yes
- No
Return part upon completion of test?*
- Yes
- No
Quantity*
Size (Dimensions)*
Pre-treated*
- Yes
- No
Full Description*
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New Customer Test Request EcoCortec

for EcoCortec

Distributor Information

Distributor Information

End User Information

Required Tests

End User Information

Required Tests

Chemical Samples

Metal Parts/ Non Chemical Samples

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