New Die Quote Form

Date: P.O. #:

Company Name: Contact:

Address: City, State, Zip:

Phone: Fax: E-mail:

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Machine Type: 650 750 7 10 13 16 Other

Gear Pitch: 1/8th C.P. 32 D.P. Reversible

D-2 Tool Steel:

Chrome Coated: Yes No

Dimension - Across Web Fractional: Decimal:

Dimension - Along Web Fractional: Decimal:

Shape: RCR: C.R. " ( ) RCS:

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CIRCLE: OVAL: BUTT-CUT: SHEETER: SPECIAL:

Irregular: Describe (if you need more space, use comments section at end):

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No. of cavities across: Space between cavities across: C to C:

No. of cavities around: Space between cavities around: C to C:

No. gear teeth: T

Roll Repeat:

Total Cavities:

Tool To: / # Liner Auto Application: Yes No

Laminated Yes No

Mark DIE #

Ship by Date: Due Date: Ship Via:

Additonal Remarks/Comments:

*Whenever possible, please ship us 'SAMPLE MATERIAL'.

Micro-Cut Technology

275 S. Third Avenue, Unit 1

La Puente, California 91746

Toll Free 800.972.5556 • Toll Free Fax 800.317.3332

Tel 626.369.2875 • Fax 626.369.9283

www.microcuttechnology.com • microcut2001@cs.com