RFQ - Samples

Plastic Tubing - Plastic Fittings RFQ Sample Form

To request a quotation, or samples of our plastic tubing or plastic fittings, please fill in the following form as completely as possible.

Note: Fields marked with an asterisk (*) are mandatory.

* Would you like a quotation, sample, or both?	QuoteSampleBoth
* Contact Name:
* Email Address:
* Company Name:
# of Employees:
Description of your Business:
* Street Address:
* City:
State / Province:
* Country:
Zip / Postal Code:
* Phone #:
Mobile #:
Fax #:
Website URL:
PRODUCT INFORMATION
Intended Application / Market:
Your Product Part#:
* Is this a new or existing application?	NewExisting
* Estimated Annual Volume:
* Type of Tubing:	CorrugatedCollapsible (expandable) Smooth flex (smooth interior corrugated tubing)
DIMENSIONAL REQUIREMENTS
Tube Diameter (ID):	6mm10mm13mm15mm 19mm22mm25mm38mm Other If Other, please specify:
Length/s required:
PLASTIC FITTINGS
Please specify GlobalMed Part# (if known) or product description if a new application:	Plastic Medical Fittings
* # of Samples Required:
Specify Material:
Comments: (Other special testing, packaging, labeling or shipping requirements)


155 N. Murray St., Trenton, Ontario, Canada K8V 5R5	Ph. 613-394-9844	Fx. 613-394-9845	email: info@globalmedinc.com

© 2007, GlobalMed Inc., All rights reserved.

Revision 1.0 - June 2007
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