Modor Plastics
245 Forrest Avenue   Hohenwald, TN  38462     P: (800)233-9354   F: (931)796-3956     
email Modor Plasticsinfo@modorplastics.com

 

 To help us aid you in your design, please take a minute and fill out this form. Thanks!

NAME:
TITLE:
COMPANY:
ADDRESS:
CITY:
STATE/PROVINCE:
ZIPCODE:
COUNTRY:
PHONE:         EXT: 
FAX:
E-MAIL ADDRESS:
WEBSITE:
PRODUCT/APPLICATION INFORMATION
Where did you hear about us?
Type of product you are interested in:
CA   CB   CC   JP   JR   Potting Shells 
Other    Please describe:      
Describe in detail your application here:
Value added services required (Please describe in comments below):
Machining     Printing     Other  
 
Estimated annual usage:
Less than 500  500 to 1000  1000 to 2500  2500 to 5000  More than 5000  
 
Timeframe for project:
Less than 1 month  1 to 6 months  6 to 12 months  More than 12 months
Additional comments or questions: