APPLICATION ENGINEERING REQUEST SHEET

Company Name___________________________________________

Address________________________________________________

               ________________________________________________

Phone Number_____________________________ Fax Number____________________________________

Contact Name______________________________________________

Date__________________

APPLICATION INFORMATION
Machine Make:
AmpEubanksKoderaMegomatSchleuniger
ArtosFilomatKomaxMetznerShinmaywa
DoremaIdealMakfilToyojamco
Other:_______________________________________________________________

Machine Model & Serial #:__________________________________________________

Wire Type_____________________________

Do you have a cord slitter or pre-slit operation?     Yes____      No_____

Processing:      One end only_____      Both ends_____

Wire Specifications:
_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

Application difficulty or other requirements:
_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

Please send two feet of the sample wire and label the sample.
Also include any sketches or drawings that may be helpful.
Thank you for your cooperation.

Send a copy of this form and your wire sample to:

Engineering Design Dept.
Lakes Precision Inc.
1900 Epler Court
PO Box 630
Three Lakes, WI
     54562



Telephone: 715-546-3070
Fax: 715-546-2565