EVR
   

 

Engineering Evaluation Request

Please fill in the form completely.  If you have questions regarding the use please contact EVR@filtec.com
Submitter Name:

 

Submitter Email Address:

 

Machine Type and Model:

 

Serial Number(s):  
Customer:  
Customer Location:  
Customer Contact:  
Required EVR COMPLETION Date:   -- mm/dd/yyyy
Project Name:  
Potential Quantity:  
Samples Required?   Yes No
RR#(if applicable):  
(If samples required, but no RR#), Date Expected:   -- mm/dd/yyyy
Probability Percentage:  

Special Discounts ?
Yes No
Details (if above is "yes"):  
Special Terms ?   Yes No
Details (if above is "yes"):  
Special Items ?   Yes No
Details (if above is "yes"):  

Description of Request -- Give specific details:


 

 

         
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