New Customer Test Request EcoCortec

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New Customer Test Request EcoCortecMiroslav Graovac2025-12-18T08:14:34-06:00

Test Request EcoCortec

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Today's Date
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User E-mail
Requested By
- Cortec Sales Manager
- Cortec Distributor
- Laboratory Employee
Name
First Last
Goal:
Distributor Information
Distributor Name
First Last
Distributor Company Name
Address
Country
Distributor Information
Distributor Name
First Last
Distributor Company Name
Distributor Address
Country
Cortec Rep Name
First Last
Company Name
Address
Country
End User Information
Name
First Last
End User Company Name
Address
Country
Sales Potential
End User Application/ Process Overview*
Test Goal
Required Tests
Required Tests
- Adhesion - Tape
- Film Mechanical Properties
- Humidity (ASTM D1735 or ASTM D1748)
- Immersion Corrosion Testing
- Oil Compatibility
- Razor Blade Test
- Rubber/Elastomer/ Compatibility
- Vapor Inhibiting Ability (VIA)
- Viscosity
- Other Tests
Please Specify Tests
End User Information
Name
First Last
End User Company Name
Address
Country
Sales Potential
End User Application/ Process Overview*
Test Goal
Required Tests
Required Tests
- Adhesion (Tape)
- Film Mechanical Properties
- Humidity
- Immersion Corrosion Testing
- Oil Compatibility
- Razor Blade Test
- Rubber/Elastomer/ Compatibility
- Vapor Inhibiting Ability (VIA)
- Viscosity
- Other
Please specify
Chemical Samples
How many samples?
Product(s) Information
- Ready to Use
- Concentrate
- Not Applicable
Recommended Dilution Rate (if applicable)
Attach SDS for each individual liquid*
Drop files here or

Accepted file types: pdf, Max. file size: 64 MB.
Product(s) Information
- Ready to Use
- Concentrate
- Not Applicable
Recommended Dilution Rate (if applicable)
Attach SDS for each individual liquid
Drop files here or

Accepted file types: pdf, Max. file size: 64 MB.
Product(s) Information
- Ready to Use
- Concentrate
- Not Applicable
Recommended Dilution Rate (if applicable)
Attach SDS for each individual liquid*
Drop files here or

Accepted file types: pdf, Max. file size: 64 MB.
Product(s) Information
- Ready to Use
- Concentrate
- Not Applicable
Recommended Dilution Rate (if applicable)
Attach SDS for each individual liquid
Drop files here or

Accepted file types: pdf, Max. file size: 64 MB.
Product(s) Information
- Ready to Use
- Concentrate
- Not Applicable
Recommended Dilution Rate (if applicable)
Attach SDS for each individual liquid
Drop files here or

Accepted file types: pdf, Max. file size: 64 MB.
Metal Parts/ Non Chemical Samples
Do you have metal parts/ non chemical samples?
- Yes
- No
Return part upon completion of test?
- Yes
- No
Quantity
Size (Dimensions)
Pre-treated
- Yes
- No
Full Description
You will receive a copy of this test request by e-mail provided above. Please save it for your records, and submit a copy with your shipment.
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