Engineering Evaluation Request
Please fill in the form completely. If you have questions regarding the use please contact EVR@filtec.com
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| Submitter Name: |
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| Submitter Email Address: |
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| Machine Type and Model: |
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| Serial Number(s): |
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| Customer: |
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| Customer Location: |
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| Customer Contact: |
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| Required EVR COMPLETION Date: |
-- mm/dd/yyyy |
| Project Name: |
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| Potential Quantity: |
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| Samples Required? |
Yes No |
| RR#(if applicable): |
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| (If samples required, but no RR#), Date Expected: |
-- mm/dd/yyyy |
| Probability Percentage: |
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| Special Discounts ? |
Yes No |
| Details (if above is "yes"): |
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| Special Terms ? |
Yes No |
| Details (if above is "yes"): |
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| Special Items ? |
Yes No |
| Details (if above is "yes"): |
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