Extrusion Die / Bushing Quote WorksheetIf you prefer to print and fax this form, click here for PDF. Please enable JavaScript in your browser to complete this form.Company Name *Contact Name *Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Email *Please provide the following information so we can determine the extrusion tooling that best suits your needs.Extrusion Head Make:Extrusion Head Model:Material:420 Stainless SteelC-276 HastelloyOther (Please Specify Below)Other:Choose Style:ABOther (Please Specify Below)Refer to STANDARD TIP DRAWINGOther: Application:PressureJacketing / SleevingTube ExtrusionOther (Please Specify Below)What type of product will this tip be used to make?Other: Compound: What material will be used to create end product?Dimensions (please specify separately if more than one size required): Refer to DIE DRAWING STYLE A OR BID (B):Land (L):OD (X) :Overall Length (Y):Reference Print Click or drag a file to this area to upload. Specify quantities requested and any special instructions:Submit
