Customer Name*

Contact Person

Contact Phone*

Fax

Address*

E-mail*

Product Name*

Application Product Location*

Usage*

Adhesion Gap
(GAP)*

Adhesion Material*

Potting/Coating Thickness*

Color*

Single Component Two Component Three Component

Remarks

Curing Method*

Room Temperature Curing Heat Curing UV Curing (If UV Curing is selected, please fill in item 7)

Operation Method*

Manual Machine

Usable Time

°C * min/hr

Initial Fixation Time

°C * min/hr

Full Curing Time

°C * min/hr

Remarks

UV Glue Irradiation Conditions:

Irradiation Wavelength (nm)

nm

Irradiation Intensity

> mW/cm² (e.g. > 50mW/cm²)

Irradiation Energy (mJ/cm²)

mJ/cm² (e.g. 1,500~3,000mJ/cm²)

Characteristic Requirements:

Flame Retardant Pressure Resistant Insulation Heat Dissipation Chemical Resistance

Viscosity (Flowability):

Pa˙s=1/1000mPa˙s cP(=mPa˙s)

Hardness:

shore A or shore D

Adhesion Strength = Shear Strength:

Kgf/cm² Psi Bar

Application Industry and Environmental Test Conditions:

Temperature Resistance Range ~ °C * High Temperature °C, Duration min, High Humidity % RH, Duration min。 Drop Test

Remarks

Relevant Certifications:

Flame Retardant (With/Without UL Yellow Card) RoHS REACH Halogen (Halogen-Free/Low Halogen) MIL NSF

Remarks

Current Usage Issues:*

Looking for Substitute Adhesive (Original Adhesive Model ), Issues:

Cost Reduction (Acceptable Price )

Sample Requirements:

Usage (Month/Year):

Other Remarks:

Adhesive inquiry form