SAMPLE REQUEST FORM

PLEASE PRINT THIS FORM AND SEND IT WITH SAMPLES TO:

AKH INC
120 Commerce Drive
Danville, IN 46122
ATTN: Sample Department

=OR=

Complete the form below prior to shipping your samples.

**This form must be fully complete in order for AKH personnel to insure that the sample is properly joined with equipment and tooling appropriate to the job. Please allow a minimum of one week in-house for us to complete and return the sample.

Name: Title:

Company:

Address:

City: State / Zip:

Phone: Fax:

E-Mail:

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Description of Application:

Prints / Sketches Enclosed: Yes No

Number of sample assemblies: Sent: To be Returned:

**INDICATE CLEARLY WHERE FAS-NERS ARE TO BE INSERTED!**

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Shipping Instructions:

IMPORTANT: SCRAP PIECES OF YOUR SAMPLE MATERIAL MUST BE INCLUDED IN ORDER TO PROPERLY CONFIRM PRESSURES AND TOOLING.

 

PLEASE PRINT THIS PAGE TO SHIP WITH SAMPLES PRIOR TO SUBMITTING THIS FORM