Request an Adhesive Sample

Please provide as much information as possible. This will allow us to verify that the product selected is going to provide you with the best solution.

Fields marked with an (*) are required.

If you have already requested an adhesive sample through our website in the past and would like another material, please contact our Application Engineering Group at 860-482-1010 for further assistance.

Contact Information

General Contact Information
*First Name:
*Last Name:
*Postal Code:

Ship to Information
Please complete if different than contact information
First Name:
Last Name:
Postal Code:

Application Information

Are you currently working with a Dymax Sales Partner?  
*If "Yes" who?

*Shipping Carrier:
**Account Number:
**An account number must be provided if you select a Federal Express or UPS service.

*End item to be manufactured with Dymax product (examples: catheter, turbine blade, cell phone, etc.):

*Describe the application (description & purpose of material):

*Substrates to be bonded or coated (list any coatings and list specific plastics):

Shadowed Areas:  

Current Method

Current Product Name:

Current Chemistry:

If "Other" or "None" Please Specify:

Proposed Process

How many parts will you manufacture per hour?  

Manufacturing Process:  

How do you plan to dispense and cure the proposed material?

Do you have a UV light source?  
*If yes, what kind?

Adhesive Requirements

*Physical Properties (viscosity, hardness/flexibility, color, clarity, or fluorescence needed):

*How do you plan to test the proposed material? (adhesion, thermal, moisture/humidity):

Additional comments or requirements:

Product(s) selected:

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