First Name
Last Name
Company Name
Address
City
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)
Phone Number (required)
Fax Number
Brush Quantities Needed
Brush Application
A. Brush Face Length (inches)
B. Brush Face Width (inches)
C. Block Length (inches)
D. Block Width (inches)
E. Block Height (inches)
F. Trim Length (inches)
G. Brush Block —Please choose an option—WoodPlasticAluminumHDPEDelrinOther
– If "Other" is selected, please indicate type
H. Fill Material —Please choose an option—NylonPolypropylenePolyesterTampicoHorse HairBrassPhosphorous BronzeStainless SteelCarbon SteelSilicon CarbideAluminum OxideOther
– If "Silicon Carbide" or "Aluminum Oxide" is selected, please indicate grit size
– Size
– Crimped Level
– Filament Color
I. Tuff Hole Diameter (inches)
J. Fill Hole Spacing Width (inches)
K. Fill Hole Spacing Length (inches)
Additional Information
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