APPLICATIONS EVALUATION •
CONTACT FORM
APPLICATIONS EVALUATION FORM
[To be completed for evaluation to be made]
Date Quote Required:
Mo/Day/Yr
Type Quote Required:
Verbal
Ballpark
Formal
Date Equipment Required:
Mo/Day/Yr
Part Description:
Application Description:
Type Application
Wire Termination Miscellaneous
Wire Splicing
Tube Sealing
Seam Welding
Spot Welding
Type of Materials:
Allowable Substitutions
Yes
No
(materials, plating, etc.)
Allowable Modifications
(stripping, plating removal, energy concentrator, etc.)
Test Requirements:
Continuity
Tensile
Hermetic
Dimensional Control Req'd:
Yes
No
Marking Allowed:
Production Rate:
Yearly: PPM:
Type of System Required:
Choose one (if applicable)
Autoshunt
Condor ST-30
Mini Condor
Micro switch
Seam welder
Splicer Model 20
Splicer Moskito ST-30
Splicer - Octopus
Splicer - Porty
Splicer - Stapla Twin
Tube Sealer
Other:
System Operation:
Manual
Semi-Automatic
Automatic
System Activation:
Foot Switch
Dual Hand
Button
Other:
Type Samples:
Sketch
Drawings
Prototype
Production
None - Explain:
Contact Information - Required*
Mr.
Ms.
Name 1st*:
Last*:
Title:
Company*:
Address*:
City
*:
State*:
Zip*:
Country:
Phone*:
Fax*:
Email*:
How did you learn of our website?:
Do you need to speak to a Stapla consultant?
Yes
No
Additional Comments:
Top of Page
