Adhesives Needs Assessment

Cox Sales Company is an industrial adhesive supplier. As an industrial supplier, we often receive inquiries requesting information on our products such as data sheets, catalogs, price list and other pertinent information. These requests are usually not specific enough for us to respond properly. In an effort to help you, please take a few moments to complete the questionnaire below. This will allow us to recommend an appropriate adhesive system specifically for your particular application. Our international efforts are targeted specifically to customers requiring a specific product for a specific application. Prices are offered based on volume and by formal quotation only. In the event you already know the product you wish to purchase, please supply us with the information requested in the following questionnaire, and we will create a quotation based on the information supplied. If you would prefer you may download a PDF copy of this questionaire and mail or fax it to us at another time.

We appreciate your interest and the opportunity to serve you.

DESCRIPTION OF APPLICATION

APPLICATION SPECIFICS

SUBSTRATES TO BE BONDED

Be exact (example: Nitrile Rubber to cold roll steel)

END PRODUCT

UNCURED HANDLING REQUIREMENTS

Viscosity (cps)		Thixotropic
Flow Needs
Pot Life
Gram Mass		Units Per Hour
Potting Mass		Approximate Dimensions
Performance Parameters
Major Approval Criteria
Shock / Cycling
Other

CURED REQUIREMENTS

SERVICE CONDITIONS

TEMPERATURE RANGE	F to F
Exposure
Exposed to:
Outdoor Weathering	Yes	No
Solvents	Yes	No
Chemicals	Yes	No
Abrasion	Yes	No
Oils / Fuels	Yes	No

PREFERRED METHOD OF APPLICATION


OTHER REQUIREMENTS OF APPEARANCE CONSIDERATIONS

(Color, Odor, Flammability, etc.)

REQUIREMENTS

Is a two-part adhesive acceptable?	Yes No
Has a bond strength requirement been established?	Yes No
If yes:	Shear (psi @ room temp)
	Peel (psi @ room temp)
Must the adhesive or the product meet a specification?	Yes No
If so please provide specification
(IE: MMM-A-131 type one class 2)

USAGE

Is this operation new?	Yes	No
Are you presently in production?	Yes	No
Estimate adhesive usage:
Per month

SOURCE OF MATERIALS

Current Supplier
Product currently being used:
Price currently being paid:
(denote units: Pints, quarts, gallons, liters, etc.)(example: $25.00 per gallon)

We appreciate your interest and the opportunity to serve you.

COMPANY INFORMATION

DESCRIPTION OF APPLICATION

APPLICATION SPECIFICS

Be exact (example: Nitrile Rubber to cold roll steel)

UNCURED HANDLING REQUIREMENTS

CURED REQUIREMENTS

SERVICE CONDITIONS

PREFERRED METHOD OF APPLICATION

OTHER REQUIREMENTS OF APPEARANCE CONSIDERATIONS

(Color, Odor, Flammability, etc.)

REQUIREMENTS

Shear (psi @ room temp)

Peel (psi @ room temp)

(IE: MMM-A-131 type one class 2)

USAGE

SOURCE OF MATERIALS

(denote units: Pints, quarts, gallons, liters, etc.)(example: $25.00 per gallon)