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New Product Request Form
First name
*
Last name
*
Company name
Email
*
Phone number
*
Product Description
*
What are you wanting designed and fabricated?
Application
*
What will this product be used for?
Forecast
*
Ballpark annual quantity
Will there be regulatory requirements, testing, and/or certifications needed for this product?
*
Please Select
Yes - this will be discussed in more detail during discovery meeting
No
Unsure
Expected Prototype Delivery Date
*
Month
/
Day
/
Year
Expectation of Price
*
Quantity Requested Now
*
Image Attachments
*
Submit Drawing or Rough Sketch
Submit