Hickson and Associates - Request for Application Assistance


Request for Application Assistance
* Required
	* Name:
	Title:
	* Telephone Number:	Ext:
	Fax Number:
	* Email:
	* Company Name:
	Address:


	City:
	* State:
	Zip code:
	Comments:
	Company Website:
	Project Name:
	Application:
	Other Application:
	Type of Material:
	Other Encapsulant:
	Operating Temperature:
	Cure Method:
	Cure Temperature:
	Cure Time:
	Viscosity:
	Encapsulation Temperature:
	UL Flammability:
	Adhesive Properties:
	Volume (Units/Year):
	Material Weight/Unit:
	Price Target:

My interest:

Immediate

1 to 2 months

3 to 6 months

> 6 months


Hickson & Associates, Inc.	Telephone: 317-844-1477
3618 Walden Place	Fax: 317-844-1478
Carmel, IN 46032	Cell: 312-560-8040
Email: sales@hicksonandassociates.com