Bolt-on Adapter Quote Worksheet

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Company Name *

Contact Name *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Extruder Make / Size:

Extruder Model / Size:

Special Requirements:

Material:

Dimensions (please specify separately if more than one size required): Refer to STANDARD BOLT-ON ADAPTER DRAWING

Centerline (Y)*:

*Centerline (Y) dimension does not apply to in-line dies.

Extruder Size (Z):

OD (X):

Reference Print

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Specify quantities requested and any special instructions:

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