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GENERAL INFORMATION
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Request for Quote
New Products
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Request for Quote Form

* Required Fields
*Company Name: Street Address:
*Name: City:
Title: State/Province:
*Phone Number: Zip/Postal Code:
*E-mail Address: Country:
*Project/Part Name:
Estimated Annual Volume (EAV):
1-99 100-499 500-999 1000-2499
2500-4999 5000-9999 Over 10,000    
Project Production Life Expectancy:
Over 5 Years 1-5 Years Less Than 1 Year
*Application Description (End use of product?, type of fluid, temperature range,
pressure, type of equipment used on etc.):
*Application and/or Specification Requirements (EPA, CARB, ANSI, SAE, etc.):
*Product Assembly BOM (List fittings, cap, pumps, hoses, printed graphics, components,
etc. If you have a sketch or a print of the product assembly, please select yes or no
below. If you mark yes, e-mail your sketch/print to us at fluids@flambeau.com
and be sure to include your project/part name in the subject line.):
Yes, I am e-mailing a sketch/print No, I do not have a sketch/print
*Target Price: *Start of Production Date:
How did you find us?:
Current Customer Web Search (engine used?)
Customer Referral Tradeshow (which show?)
Trade Magazine      
Additional Information:
Our privacy policy is simple. We do not share, sell or distribute any of the information
you provide us outside of the purpose for which the information was given.