Complete this form and fax to Fluoron: 410-392-4357
Contact:
Phone:
Company:
Fax:
Address:
    
 
State/Province:
City:
Zip:
Date of Shutdown:     Hours  
PM# 
Product:
Roll Cleaning Fluoro-Stat 102 Covers  Fluoro-Wear 102 Covers 
Fluoro-Coat X-550  Fluoro-Coat 200  Dryer Covers 
FEP Covers
 

For Roll Covers Only

Type "A" Bondable

Type "N/A" Non-Bondable
 
.020" Thick
.060" Thick
 
Fluoro-Wear 402 Sheet 
 
 
Diameter(s):  "
Face Length:  "
Quantity: 
307 De-Inking Covers
**The following are only if applicable**

1. What type of "stickies" are you trying to release? 

2. Percentage and kind of recycle? 

3. Do you have a spare roll for this application?  Yes  No

4. How many hours do we have to complete this job? 

5. Roll Surface Temp:  Machine Speed:  fpm

6. Roll Surface:  Elastomer (Specify Type)

7. Roll Type:  (Please Specify) 

Comments: