Trial Request Form

Title*:

First Name*:

Last Name*:

Company*:

Address*:

Phone:

Email*:

Request Date:

Raw Materials

Please fill in or select your values. If a value is not known, default to 0.

Component Label	Material Type	Material Grade	Material Supplier	Material State	Bulk Density [g/dm³]	Viscosity [mPa x s]	Melting Temp. [°C]	Harmful Goods [Yes / No]

Formulations

Please type in your values and ensure that the sum per formulation is 100%.

Component Label	Formulation 1 [%]	Formulation 2 [%]	Formulation 3 [%]	Formulation 4 [%]	Formulation 5 [%]	Formulation 6 [%]

Application

Trial Target

Processing and performance goals. What shall be improved?

Quality Control

What are the quality/performance targets of the product? What tests need to be applied?

Sample Taking

How often and in which quantity shall we take samples?

Previous Experience

Is there any experience on an existing Buss line, or another compounding technology/machine? If yes, which one?

Desired Trial Date

INDICATION ONLY – TO BE CONFIRMED BY BUSS

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