Sample Request

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After you click "Submit," the E-mail will be sent to a KDM Sales representative.  Please verify that your information is correct and accurate before you click "Submit".  All information in bold is required.

Contact Information
Name
Company
Address
Address Cont'd
City / State / Zip code
Country
Email
Phone
Fax
   
Please help us to help you by answering the following questions:
   
How did you find us?
   
Market Classification
   
Program Description
   
Sample Requested*

* Please include length, thickness, width, ounces, size of product and any other details regarding the sample requirements

   
Sample 1
Sample 2
Sample 3
Sample 4
   
Please Have someone call me
   

Application Details - All questions are required
Please tell us about the application so that we may help you use our products

   
What is the temperature range requirements for the sample (>150șC)
 
   
Are there any environmental concerns (out gassing, VOC's) requirements for

the sample?

 No
  Yes, Describe
   
Will the samples or products be used in a trial application?
  YesNo  
   

Will sample evaluation be done in a laboratory or controlled location?
  YesNo  
   

What is the testing timeline for the sample. How long will it take to evaluate

the product?
   

Is the sample to replace existing product(s) or as an alternative to another

type of product?

YesNo  
   

Do you currently get this product elsewhere?
  YesNo  
   

When is the best time for KDM Sales to follow up on the samples?

   

 

    
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