Sample Request

Please complete this short form below for each desired color match. Submit a copy, and send it to us with two identical “color standards.” The color standards should be coated pieces that accurately represent the desired color, gloss level, and substrate of your finished product. One color standard is used during the matching process while the other is left untouched and retained for future batch-to-batch comparisons. A member of our staff will contact you once we have received your color standards and completed Sample Request Form.

Name: (required)
Title:
Company: (required)
Address:
Address Line 2:
City: (required)
State/Prov.: (required)
Zip/P.C.:
Country:
Phone: Ext.: (required)
Fax:
E-mail: (required)

Color Name/Description (and part # if known):

Type of Container (Check all that apply):
 12 oz. Aerosol
       Approximate Usage Qty. (100 min.):
 6 oz. Aerosol
       Approximate Usage Qty. (100 min.):
 Brush-in-Lid Bottle
       Approximate Usage Qty. (100 min.):
 Paint Marking Pen
       Approximate Usage Qty. (100 min.):
 Other (Describe in “Special Notes” below)
       Approximate Usage Qty. (100 min.):

Approximately how long will above Order Quantity last? Months

Additional Information
Type of surface to be touched up:
 Bare metal Painted Other
Describe:

Primary Light source? Check all that apply. (If more than one, list in “Special Notes”.)
 Daylight Fluorescent Incandescent

Resin system type? (see notes below)
 No preference Enamel Lacquer

Aerosol spray pattern?
 Fan Round N/A Other
Describe:

Aerosol carton size?
 12-pak 6-pak N/A Other
Describe:

Aerosol cap type?
 Small 1 inch stacker cap Large double-shelled (DS) cap N/A

Labeling Requirements
 No preference (Custom-Pak stock label)
 * Semi-private label using your company logo
 * Multi-color private label
* – One-time label development charges will apply

Special Notes?
(Provide details about your Sample Request, i.e. performance requirements, VOC issues, etc.)

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