Product Enquiry Form

Please take a moment to complete the following form,
so that we can refer the right product to you:

Company Name:
Contact Name:
Mailing Address:
Shipping Address:
City:
Province / State:
Country:
Postal / Zip Code:
Telephone Number:
Toll Free Number:
Fax Number:
Email Address:

Product Information

Please specify exact type of material to be bonded:

Substrate:

Substrate:

Rigid

Smooth

Porous

Flexible

Rough

Non-porous

Process Requirements

Applied by hand

Immediate bonding

Brush

Applied by machine

Delayed bonding

Knife coat

Roller coat

Spray

Extrude

Dip

Pre-applied

Other

Open time required:

Fixturing time required:

Preferred Form

Structural

Non-structural

Solvent-based flammable

Solvent-based
non-flammable

Water based

Bonding tape

Single-sided application

Two-sided application

Two-part mix

Hot melt

Aerosol

Other

Performance Requirements

High temperature continuous °F High temperature intermittent °F

Low temperature °F Moisture resistance

U.V. resistance Tensile stress loads

Shear stress loads Clevage stress loads

Peel stress loads Flexible bondline

Chemical resistance Immediate need

Future need New project

Existing project

Adhesive currently used:

Price / product size:

Estimated monthly volume:

Additional Comments

To learn about the benefits of ordering your Adhere products on-line, please contact one of our company reps.

For more information about our products, please complete our product enquiry form.

For more information, please email us at adhere@adheredist.com, or call us today at 1-800-665-7962 (Canada) or
1-204-694-1660.

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