First Name*

Last Name*

Company*

Address

Street Address

Address Line 2

City

State / Province / Region
AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip / Postal Code

Country

Phone*

Fax

Email*

Application

Provide a brief description of your application; if there are privacy issues, please call us at 717.274.1800:

Product Dimensions - Please specify Pipe or tubing products:

O.D. (Outside Diameter)

I.D. (Inside Diameter)

Wall Thickness

Length

Rod products, please specify:

Diameter

Length

Quantity Required

Unit of Measurment
FeetPieces

Lengths - Specify length(s) and unit of measurement

Tolerances
SelectYesNo

Dara Standard

Materials
Select materialABS Cycolac, Lustran, MagnumAcrylic PlexiglassCellulose AcetateCellulose Acetate Butyrate-CABCellulose PropionateCopolysters Kodar PETGHigh Density Polyethylene (H.D.P.E.)Medium Density Polyethylene (M.D.P.E.)Low Density Polyethylene (L.D.P.E.)Polystyrene (H.I.P.S.) & (G.P.P.S.)PVDF KynarPolycarbonate Lexan Makrolon CalibrePolypropyleneThermoplastic Elastomer TPE's Santoprene Pebex KratonPolysulfone UdelOther_Material

Aesthetic Requirements
HighMediumNon Critical

Drawing Available
Please select an optionYesNo

Color

Color Match Required?
YesNo

Color Chip Available?
YesNo

Mating Parts?
YesNo

Packaging
Bulk on skidCartons*

*If cartons, specify pieces per carton or max. weight per carton

Comments/Notes