Name*  
                                 (* required field)  
                              
                                 
                               
                             
                            
                              Title  
                              
                                 
                               
                             
                            
                              Company*   
                              
                                 
                               
                             
                            
                              Street
                                Address*   
                              
                                 
                               
                             
                            
                              Shipping
                                Address*   
                              
                                 
                               
                             
                            
                              City*   
                              
                                 
                               
                             
                            
                              State
                                / Province*   
                              
                                
                                  Select One 
                                  Alabama  
                                  Alaska  
                                  Arizona  
                                  Arkansas  
                                  California  
                                  Colorado  
                                  Connecticut  
                                  Delaware  
                                  Dist. of Columbia  
                                  Florida  
                                  Georgia  
                                  Hawaii  
                                  Idaho  
                                  Illinois  
                                  Indiana  
                                  Iowa  
                                  Kansas  
                                  Kentucky  
                                  Louisiana  
                                  Maine  
                                  Maryland  
                                  Massachusetts  
                                  Michigan  
                                  Minnesota  
                                  Mississippi  
                                  Missouri  
                                  Montana  
                                  Nebraska  
                                  Nevada  
                                  New Hampshire  
                                  New Jersey  
                                  New Mexico  
                                  New York  
                                  North Carolina  
                                  North Dakota  
                                  Ohio  
                                  Oklahoma  
                                  Oregon  
                                  Pennsylvania  
                                  Rhode Island  
                                  South Carolina  
                                  South Dakota  
                                  Tennessee  
                                  Texas  
                                  Utah  
                                  Vermont  
                                  Virginia  
                                  Washington  
                                  West Virginia  
                                  Wisconsin  
                                  Wyoming  
                                  --------------- 
                                  Alberta 
                                  British Columbia 
                                  Manitoba 
                                  New Brunswick 
                                  Newfoundland 
                                  Northwest Territories 
                                  Nova Scotia  
                                  Nunavut 
                                  Ontario 
                                  Prince Edward Island 
                                  Quebec 
                                  Saskatchewan 
                                  Yukon 
                                 
                               
                             
                            
                              Zip
                                / Postal Code*   
                              
                                 
                               
                             
                            
                              Country*   
                               
                                
                                  Select One 
                                  ____________________  
                                  United States  
                                  Canada  
                                  Japan  
                                  United Kingdom  
                                  Australia  
                                  Germany  
                                  France  
                                  Switzerland  
                                  Italy  
                                  Netherlands  
                                  ____________________  
                                  Albania  
                                  Algeria  
                                  American Samoa  
                                  Andorra  
                                  Anguilla  
                                  Antartica  
                                  Antigua & Barbuda  
                                  Argentina  
                                  Armenia  
                                  Aruba  
                                  Australia  
                                  Austria  
                                  Azerbaijan  
                                  Bahamas  
                                  Bahrain  
                                  Bangladesh  
                                  Barbados  
                                  Belarus  
                                  Belgium  
                                  Belize  
                                  Benin  
                                  Bermuda  
                                  Bhutan  
                                  Bolivia  
                                  Botswana  
                                  Bouvet Island  
                                  Brazil  
                                  British Indian Ocean Terr.
                                   
                                  Brunei Darussalam  
                                  Bulgaria  
                                  Burkina Faso  
                                  Burundi  
                                  Cambodia  
                                  Cameroon  
                                  Canada  
                                  Cape Verde  
                                  Cayman Islands  
                                  Central African Republic
                                   
                                  Chad  
                                  Chile  
                                  China  
                                  Christmas Island  
                                  Cocos (Keeling) Isl  
                                  Colombia  
                                  Comoros  
                                  Congo  
                                  Cook Isl  
                                  Costa Rica  
                                  Cote D'Ivoire  
                                  Croatia  
                                  Cyprus  
                                  Czech Republic  
                                  Denmark  
                                  Djibouti  
                                  Dominica  
                                  Dominican Republic  
                                  East Timor  
                                  Ecuador  
                                  Egypt  
                                  El Salvador  
                                  Equatorial Guinea  
                                  Estonia  
                                  Ethiopia  
                                  Faeroe Islands  
                                  Falkland Isl. (Malvinas)
                                   
                                  Fiji  
                                  Finland  
                                  France  
                                  French Guiana  
                                  French Polynesia  
                                  French Southern Terr.  
                                  Gabon  
                                  Gambia  
                                  Georgia  
                                  Germany  
                                  Ghana  
                                  Gibraltar  
                                  Greece  
                                  Greenland  
                                  Grenada  
                                  Guadeloupe  
                                  Guam  
                                  Guatemala  
                                  Guernsey, C.I.  
                                  Guinea  
                                  Guinea-Bissau  
                                  Guyana  
                                  Haiti  
                                  Heard and McDonald Isl  
                                  Honduras  
                                  Hong Kong  
                                  Hungary  
                                  Iceland  
                                  India  
                                  Indonesia  
                                  Ireland  
                                  Isle of Man  
                                  Israel  
                                  Italy  
                                  Jamaica  
                                  Japan  
                                  Jersey, C.I.  
                                  Jordan  
                                  Kazakhstan  
                                  Kenya  
                                  Kiribati  
                                  Korea, Republic of  
                                  Kuwait  
                                  Kyrgyzstan  
                                  Laos  
                                  Latvia  
                                  Lebanon  
                                  Lesotho  
                                  Liberia  
                                  Liechtenstein  
                                  Lithuania  
                                  Luxemborg  
                                  Macau  
                                  Madagascar  
                                  Malawi  
                                  Malaysia  
                                  Maldives  
                                  Mali  
                                  Malta  
                                  Marshall Isl  
                                  Martinique  
                                  Mauritania  
                                  Mauritius  
                                  Mexico  
                                  Micronesia  
                                  Moldova, Republic of  
                                  Monaco  
                                  Mongolia  
                                  Montserrat  
                                  Morocco  
                                  Mozambique  
                                  Myanmar  
                                  Namibia  
                                  Nauru  
                                  Nepal  
                                  Netherland Antilles  
                                  Netherlands  
                                  New Caledonia  
                                  New Zealand  
                                  Nicaragua  
                                  Niger  
                                  Nigeria  
                                  Niue  
                                  Norfolk Isl  
                                  Northern Mariana Isl  
                                  Norway  
                                  Oman  
                                  Pakistan  
                                  Palau  
                                  Panama  
                                  Panama Canal Zone  
                                  Papua New Guinea  
                                  Paraguay  
                                  Peru  
                                  Philippines  
                                  Pitcairn  
                                  Poland  
                                  Portugal  
                                  Puerto Rico  
                                  Qatar  
                                  Reunion  
                                  Romania  
                                  Russian Federation  
                                  Rwanda  
                                  Saint Kitts & Nevis  
                                  Saint Lucia  
                                  Samoa  
                                  San Marino  
                                  Sao Tome & Principe  
                                  Saudi Arabia  
                                  Senegal  
                                  Seychelles  
                                  Sierra Leone  
                                  Singapore  
                                  Slovakia  
                                  Slovenia  
                                  Solomon Islands  
                                  Somalia  
                                  South Africa  
                                  Spain  
                                  Sri Lanka  
                                  St. Helena  
                                  St. Pierre and Miquelon  
                                  St. Vincent & Grenadines
                                   
                                  Suriname  
                                  Svalbard & Jan Mayen Isl  
                                  Swaziland  
                                  Sweden  
                                  Switzerland  
                                  Taiwan  
                                  Tajikistan  
                                  Tanzania, United Republic
                                   
                                  Thailand  
                                  Togo  
                                  Tokelau  
                                  Tonga  
                                  Trinidad & Tobago  
                                  Tunisia  
                                  Turkey  
                                  Turkmenistan  
                                  Turks and Caicos Isl  
                                  Tuvalu  
                                  U.A.E.  
                                  U.S.Minor Outlying Isl  
                                  Uganda  
                                  Ukraine  
                                  United Kingdom  
                                  United States  
                                  Uruguay  
                                  Uzbekistan  
                                  Vanuatu  
                                  Vatican City State  
                                  Venezuela  
                                  Viet Nam  
                                  Virgin Isl (British)  
                                  Virgin Isl, (U.S.)  
                                  Wallis & Futuna Islands
                                   
                                  Western Sahara  
                                  Yemen, Republic of  
                                  Zaire  
                                  Zambia  
                                  Zimbabwe  
                                 
                                   
                             
                            
                              Telephone*   
                              
                                 
                               
                             
                            
                              Fax  
                              
                                 
                               
                             
                            
                              Email  
                              
                                 
                               
                             
                            
                              Company
                                Web Site  
                              
                                 
                               
                             
                            
                              Tell
                                us about the parts enclosed   
                                (if submitting more than one part, please complete
                                and print a new Application Test Form for each
                                part, then attach the form to each corresponding
                                part.) 
                             
                            
                              Country
                                where the  
                                part will be decorated*   
                              
                                 
                               
                             
                            
                              Describe
                                the part  
                                and end product*   
                              
                                 
                               
                             
                            
                              Substrate
                                material*    
                                (If coated, with what?  
                                Be specific.)  
                              
                                 
                               
                             
                            
                              How
                                is the part produced?*   
                                (i.e. painted metal casting, molded, powder-coated
                                stamped)  
                              
                                 
                               
                             
                            
                              If
                                molded, select process:  
                              
                                
                                  Select One 
                                  Injection Molded 
                                  Rotationally Molded 
                                  Blow Molded 
                                  Compression Molded 
                                  Thermoformed 
                                  Other 
                                 
                               
                             
                            
                              If
                                "Other", please specify  
                              
                                 
                               
                             
                            
                              Type
                                of mold release  
                              
                                 
                               
                             
                            
                              Number
                                of graphics  
                                needed on each part   
                              
                                 
                               
                             
                            
                              Size
                                of graphic  
                              
                                 
                               
                             
                            
                              Number
                                of colors  
                              
                                 
                               
                             
                            
                              Annual
                                volume 
                                of enclosed parts  
                              
                                 
                               
                             
                            
                              Current
                                decorating method  
                              
                                 
                               
                             
                            
                              Current
                                decorating problems  
                              
                                 
                               
                             
                            
                              Additional
                                comments 
                                and concerns