Thank you very much for your showing interest in Z CLEAN™.
We would like to request that you complete and send the questionnaire below when requesting a sample.
We will send you a free sample at a later date.

Contact information (sample delivery address)

If your contact information and your shipping address are different, enter the sample shipping address in the remarks field.

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Your Company Business

Questionnaire

Q1Tell us which molding machine you use. (Multiple answers possible)

Q2Currently, how do you clean the inside of your molding machine? (Multiple answers possible)

Q3Molding machine to be evaluated. (Multiple answers possible)

We will use our own discretion to select the grade of the free sample to send to you the quantity thought to be necessary for one evaluation. Please complete the questionnaire below to select the quantity and grade required for your evaluation.
(You may reply to the extent you are able to answer)

Molding machine and resin to be evaluated Size

Mold clamping force

Auger diameter

Q4What kind of resin do you use? (multiple answers possible)

Q5What kind of cleaning will you implement? (Multiple answers possible)

Visit the line up page for a list of upgrades and how to select one.

Remarks

Enter any inquiry or the like.
If your contact information and your shipping address are different, enter your shipping address here.

Please be aware that one of our representative may contact you directly to
select the appropriate grade and to confirm the quantity required for evaluation.