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First Name

Last Name

Company

Address

Address Line 1

Address Line 2

City

State

Zip

E-mail Address

Current purging compound supplier grade and consumption (if used)

Application and process (injection, extrusion, ISBM, EBM, cast film, etc.)

Resins to be cleaned

Melt temperature range

Food contact required FDA, EU, or other

If purging a hot runner, minimum gate sizes

Are there highly polished/mirrored surfaces in the mold?

Additional comments

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