Company                  Telephone Number 

Contact Name            Extension             

Title                          Fax Number         

Mailing Address 1       Email Address      

Mailing Address 2   

City                       

State                      -- AK AL AR AZ CA CO CT DC DE FL GA HA IA ID IL IN KS KY LA MA MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY

Zip Code               

Shipping Address 1

Shipping Address 2

City                      

State                     -- AK AL AR AZ CA CO CT DC DE FL GA HA IA ID IL IN KS KY LA MA MN MO MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY

Zip Code              

Application Description

Substrate Material                                                  Press Manufacturer

  Paper                             Opaque                       Press Model   

  Film                                Translucent                  Maximum Web Speed  

  Foil                                Transparent                 Maximum Web Width  

Is solvent ink used?             Yes           No

Web Process                                                      Type of Application

   Gravure                                                          Print

   Flexographic                                                   Embossing

   Offset                                                             Coatings

   Screen                                                            Other  

   Other  

Quotation Type Requested

BST Pro Mark                   Video Inspection                    Web Guide

Powerwise Ink Pumps     Electric                    Air                      Parastaltic

Pamarco                           Anilox Rollers                         Hand Proofers

S & B Equipment              EZ Cab             EZ Cleaner             EZ Vac         

                                         EZ Complete     EZ Cart                  EZ Traverse

Andreotti Equipment       Chamber Blade System                    G2 Chamber Blade

Doctor Blade Material    Type            Width  

Special Instructions/Lists of Equipment/Notes