Name (First and Last):*  

Title:

Company Name:*   

Street Address:* 

City:*    State:*    Zip:* 

Country: 

Work Phone:*    Fax:

E-Mail Address:*   

Type of material being sealed:  

Thickness of blister:     Thickness of card: 

Size of card:     Depth of blister:  

Size of blister flange (total area or width):  

This is the:     Total area      Width

Tool Material:
Aluminum     Wood    Phenolic    Other

If other:

If wood:   Type of board:         Finished height of seal tool:  

Number up (# of outs):  

Sealer pad material:
Cork    Cork with silicone  Rubber  Silicone rubber  Other

 If other:   Thickness:

Outside dimension of finished seal tool:

Spring pins:
Yes    No

Type :   Quantity: