Application Evaluation Request
Name		Title
Company
Address		City, State, Zip
Tel		Fax
Web Site		Email
Production Parts
Functional Description of Parts
Material		Alloy Spec
Condition		Thickness
Diameter		Length
Acceptable Alternative Materials
If necessary, can part be redesigned to adapt to the Magneform Process?			Yes No
To what extent?
Operation to be performed by Magneform
Present Production Method
Type of Operation	Manual Semi-Automatic Automatic	Skilled Operator Required	Yes No
Present Production Rate		Production Lot Size
Estimated Annual Production		Type of Application	Production Prototype Experimental
Test Reqmts.
What advantages do you expect to derive from Magneform?
Where did you first hear about Magneform?		Associate Media Advertising Direct Mail Trade Show Other
If other, Please explain