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Print this Order Form, then Mail or Fax to:
34230 Riviera Drive, Fraser, Michigan 48026
Fax: (586) 296-5802
| Company Name |
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| Contact
Name |
 |
| Title |
 |
| Phone |
Fax
 |
| Email |
 |
| P.O. Number |
 |
| Requisition # |
 |
| Date Required |
(example: 01/20/2001) |
| Ship Via |
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| Master Die Size |
 |
O.D.
X I.D.
X Thickness
 |
| Material Type |
 |
| Temper |
 |
| Part Number |
 |
| Drawing Attached |
 |
| Previous Job # |
 |
| Quote Number |
 |
| Other
Comments |


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Ordering As Follows: |
|
Quantity |
Material* |
Detail
Number |
Comment |
|
 |
 |
Punch
(1) |
Spring Pin Yes No |
|
 |

|
Die
Button (2) |
Lock Pin Yes No |
|
 |

|
Compound
(3) |
|
|
 |

|
Knockout
(4) |
Shedder Pin Yes No |
|
 |

|
Stripper
(5) |
Stop Pin Yes No |
*Unless otherwise directed, tooling material is
M-4 on 1-1/2" Inserts, M-2/D-2 on all others.
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