First Name
Last Name
Company Name
Address
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State —Please choose an option—AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaVirgin IslandsWashingtonWest VirginiaWisconsinWyoming
Zipcode
Company Type DistributorWholesalerManufacturerConsumerOther
If you chose "Other" as Company Type, please explain
Email (required)
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Fax Number
Brush Quantities Needed
Brush Application
A. Overall Length (inches)
B. Size of Channel – Channel Height (inches)
– Channel Width (inches)
C. Overall Trim (inches)
D. Trim Profile —Please choose an option—FlatBevelShaved EndOffsetStepped
E. Brush Shape —Please choose an option—HelicalInternal RingExternal RingFormed Cup BrushFormed Strip BrushStraightCoiledCylinders
F. Brush Fill —Please choose an option—HeavyMediumLight
G. Brush Filament Diameter (inches)
H. Filament Type —Please choose an option—NylonPolypropylenePolyesterTampicoHorse HairBrassPhosphorous BronzeStainless SteelCarbon SteelSilicon CarbideAluminum OxideOther
– If "Silicon Carbide" or "Aluminum Oxide" is selected, please indicate grit size
– If "Other" is selected, please indicate type
– Crimped Level
– Filament Color
I. Channel Material —Please choose an option—AluminumStainless SteelGalvanizedSteelOther
– If "Other" is selected, please indicate type:
Additional Information
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