Sample Request Form

Request for Samples
 
Name
Company Name
Title
Company Address

Phone
FAX
E-mail

 

How did you come to our website? search referral advertisement
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:
other:
 
Grade or Hardness (if known): Shore A Shore D
 
R/O filler: no yes, specify:
other: Quantity or length:
 
Properties of material (if material not specified above)
other:
 
Material (inner layer or stripe):
other:
Grade or Hardness (if known): Shore A Shore D
R/O Filler: yes no
Braiding material
 
Other
 
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This is a subscription feature. If you choose to join our update notification we will send you an e-mail inviting you to visit the specific page(s) that have been changed, like our news page or tube of the month page. You will not automatically recieve e-mail from PEI without signing on for this feature. You will not recieve unsolicited SPAM. Your contact information WILL NOT EVER be sold to or shared with anyone else.