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Name
Company Name
Title
Company Address
Phone
FAX
E-mail
How did you come to our website?
search
referral
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other:
WILL A DRAWING OR SPEC BE SENT? (this is a must for multi-lumen tubes)
YES
NO
Type of tube:
single lumen
multi-lumen
braided
stripe
coextrusion
other:
Application
General samples required:
misc
multi-lumen
other:
OD:
ID:
WALL:
Or specific size:
inch
mm
Material:
-- Choose One --
PVC
LDPE
HDPE
Polypropylene
Polyurethane
Nylon
PEBA
PEBAX ®
Polycarbonate
PET
ThermoPlasticElastomer (TPE)
ThermoPlasticRubber (TPR)
HYTREL ®
C-Flex TPR ®
LCP
Other
other:
Grade or Hardness (if known):
Shore A
Shore D
R/O filler:
no yes, specify:
-- Choose One --
Barium
Bismuth
Tungsten
Other
-- Choose One --
15%
20%
25%
30%
35%
40%
Other
other:
Quantity or length:
Properties of material (if material not specified above)
-- Choose all that apply --
Soft and Flexible
Hard and Rigid
Kink resistant
Gamma Sterilizable
ETO sterilizable
Solvent bondable
Class VI
Other
other:
Material (inner layer or stripe):
-- Choose One --
PVC
LDPE
HDPE
Polypropylene
Polyurethane
Nylon
PEBA
PEBAX ®
Polycarbonate
PET
ThermoPlasticElastomer (TPE)
ThermoPlasticRubber (TPR)
HYTREL ®
C-Flex TPR ®
LCP
Other
other:
Grade or Hardness (if known):
Shore A
Shore D
R/O Filler:
yes
no
Braiding material
Other
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