Application Request Form

Date:Click or tap to enter a date.
Customer Information:

Company name:	Click or tap here to enter text.
Contact name:	Click or tap here to enter text.
Telephone:	Click or tap here to enter text.
Address:	Click or tap here to enter text.
E-mail address:	Click or tap here to enter text.

Corporate specifications for components/brands on OEM equipment? Yes☐ No☐
(if yes, customer specs must be submitted with this form to receive a quote)
Company paint scheme requirement? Yes☐ No☐
(if yes, customer specs must be submitted with this form to receive a quote)

Part Description:

General part description	Click or tap here to enter text.
Part material	Click or tap here to enter text.
Is the part in production?	Yes☐ No☐
If no, when will it be in production?
Are samples available?	Yes☐ No☐
If no, when will samples be available?
Has CDMC received samples?	Yes☐ No☐

Notes:Click or tap here to enter text.

Customer Goals and Requirements:

Customer goal	Click or tap here to enter text.
Present method (if any)	Click or tap here to enter text.
Desired method (if any)	Click or tap here to enter text.
Present media used (if any)?	Click or tap here to enter text.
Desired media used (if any)?	Click or tap here to enter text.
Incoming condition (I.e. dry, clean, oily, etc.)?	Click or tap here to enter text.
Previous operation?	Click or tap here to enter text.

Notes:Click or tap here to enter text.

Part specific details:

General part specifications	Click or tap here to enter text.
Chamfer/edge-break specifications	Click or tap here to enter text.
Measurement method (define clearly)	Click or tap here to enter text.
Part orientation concerns?	Yes☐ No☐Click or tap here to enter text.
Critical areas not to disturb/alter (if any)?	Yes☐ No☐Click or tap here to enter text.

Notes:Click or tap here to enter text.

Burr specifications and details:

Number of surfaces with burrs	Click or tap here to enter text.
Define burr locations	Click or tap here to enter text.
Variability in burrs	Click or tap here to enter text.
What process creates the burr (I.e. grinding/turning/etc.)?	Click or tap here to enter text.
Is the burr area free-access or masked	Click or tap here to enter text.
Description of all operations (if known)	Click or tap here to enter text.
Is finish a concern (if yes, please specify what and where)	Click or tap here to enter text.
General machine specifications and requirements	Click or tap here to enter text.

Notes:Click or tap here to enter text.

Volume requirements:

Machine cycle time required	Click or tap here to enter text.
Expected annual volumes	Click or tap here to enter text.
Number of shifts for machine to be operated	Click or tap here to enter text.
Hours per day/shift	Click or tap here to enter text.
Efficiency rating (if known)	Click or tap here to enter text.

Notes:Click or tap here to enter text.

Other Machine Details:

Loading desire (manual or auto)	Click or tap here to enter text.
Part clamp requirements/concerns (if any)	Click or tap here to enter text.
Wear adjustment (manual, pneumatic, or auto amp comp)?	Click or tap here to enter text.
Size limitations for equipment/space allowed	Click or tap here to enter text.
Machine color (Standard is RAL 7035 grey)	Click or tap here to enter text.

Notes:Click or tap here to enter text.

Will coolant or cutting fluid be used? Yes☐ No☐
(if yes, coolant specs and MSDS must be submitted with this form to receive a quote)
Notes:Click or tap here to enter text.

Multiple part-processing machines only:

General range of parts (describe)	Click or tap here to enter text.
Min/max-i.d./o.d.	Click or tap here to enter text.
Current changeover time and frequency?	Click or tap here to enter text.
Desired changeover time and frequency?	Click or tap here to enter text.
Setup time required?	Click or tap here to enter text.

Notes:Click or tap here to enter text.

End-user facility information:

What voltage is required/available?	Click or tap here to enter text.
Is shop air available (80 psi, clean and dry)?	Yes☐ No☐Click or tap here to enter text.
Are there any dba level concerns?	Yes☐ No☐Click or tap here to enter text.
Should the quote include dust collection?	Yes☐ No☐Click or tap here to enter text.
Is this machine intended for a union shop?	Yes☐ No☐Click or tap here to enter text.

Notes:Click or tap here to enter text.

Other project details:

Should the quote include a shipping estimate to end-user facility?	Yes☐ No☐Click or tap here to enter text.
Should the quote include onsite integration at end-user facility?	Yes☐ No☐Click or tap here to enter text.
Should the quote include automation?	Yes☐ No☐Click or tap here to enter text.
Should the quote include a wash system?	Yes☐ No☐Click or tap here to enter text.
Should the quote include special or spare tooling?	Yes☐ No☐Click or tap here to enter text.
Should the quote include a quote for perishable items?	Yes☐ No☐Click or tap here to enter text.
Is this a funded project?	Yes☐ No☐Click or tap here to enter text.
If yes, how has the budget been determined?
Is there a desired cost per part basis for this budget (if yes, describe)?	Yes☐ No☐Click or tap here to enter text.

Notes:Click or tap here to enter text.

Other information/Notes:

Will customer visit CDMC for runoff? Yes☐ No☐
(If not, machine MUST be signed off on by customer prior to shipping).
Standard 8-hour run off at CDMC is included in price/if a different type of run off needs to occur, please define and we will quote.

Notes:Click or tap here to enter text.