Subject:

Your Name:

Your Email Address:

Your Telephone number:

Your Fax number:

Company name:

Company address:

PO Box

City:

State:

Zip:

Country:

Company Telephone:

Company Fax:

If other please specify:

Sales repReferralTelemarketerExisting customer .Other-select one-
Quantities to quote using Soft Tooling (prototype)

Quantities to quote using Hard Tooling (production)

Number of switches

Number of actuations

Actuation force (if known)

Tactile Ratio (if known : non-tactile = 0%)

Key Travel (if known)

Brief description of your company: (Required)