NORTHERN ILLINOIS MOLD TEL. (847) 669-2100
11200 EAST MAIN STREET FAX       (847) 669-2154
HUNTLEY, ILLINOIS   60142
COMPANY NAME:              
PART NAME:              
NO. OF CAVITIES:     PART NO:      
NO. OF CAVITIES:     PART NO:      
TYPE OF MOLD [   ]  THERMOSET [   ]    INLINE [   ]  INJECTION [   ]  COMPRESSION [   ] THERMOPLASTIC [   ] OTHER
         INJECTION         COMPRESSION        TRANSFER            INJECTION          
MOLD CONSTRUCTION SPECIAL FEATURES EJECTION
Cavity Forces
[   ] Standard [   ] Guide Pins & Bushings in EJ Bar [   ] EJ Pins [   ]
[   ] 3 Plate [   ] Spring Loaded EJ Bar [   ] EJ Blade [   ]
[   ] Stripper [   ] Inserts Molded in Place [   ] Sleeve [   ]
[   ] Hot Runner Bar [   ] Ejector Bar/Stationary Side [   ] Stripper [   ]
[   ] Insulated Runner [   ] Accelerated EJ [   ] Air [   ]
[   ] Cold Runner Manifold [   ] Positive EJ Return [   ] Special Lift [   ]
[   ] Vacuum System [   ] Hyd. Operated EJ Bar [   ] Unscrewing(Auto) [   ]
[   ] Other [   ] Parting Line Locks [   ] Removable Insert [   ]
[   ] Other: ______________________ [   ] (Hand) [   ]
[   ] Other [   ]
MATERIAL HARDNESS TEMP CONTROL
Cavity Forces Cavities Forces Cavity Core
v Tool Steel [   ] [   ] Hardeneed [   ] [   ] Inserts [   ]
[   ] Beryl. Copper [   ] [   ] Pre-Hard [   ] [   ] Retainer Plate [   ]
[   ] Steel Sinking [   ] [   ] Soft [   ] [   ] Other Plates [   ]
[   ] Other [   ] [   ] Other [   ] [   ] Bubblers [   ]
[   ] Heaters [   ]
MOLD BASE [   ] Other  [   ]
___ #1       ___ #2  ___ #3 (Specify)__________________
FINISH SIDE ACTION TYPE OF GATE
Cavity Forces Cavities Forces
[   ] SPI/SPE# [   ] [   ] Angle Pin [   ] [   ] Edge
[   ] Mach Finish [   ] [   ] Hydraulic Cyl [   ] [   ] Center Sprue
[   ] Chrome Plate [   ] [   ] Air Cylinder [   ] [   ] Sub-Gate
[   ] Texture [   ] [   ] Cam [   ] [   ] Pin Point
[   ] Other [   ] [   ] EJ Activated [   ] [   ] Direct Gate
[   ]  Spring Load [   ] [   ] Gate Shut-Off
[   ] Other [   ] [   ] Other
ENGRAVING DESIGN BY TITLE OF DESIGN MICRO SWITCHES
[   ] Yes [   ] Moldmaker [   ] Detailed Design [   ] Supplied By ______________
[   ] No [   ] Customer [   ] Layout Only [   ] Mounted by Moldmaker
Approximate Mold Size ________________________
Heaters Supplied By [   ] Moldmaker [   ] Customer
Duplicating Casts [   ] Moldmaker [   ] Customer
Mold Try-Outs By [   ] Moldmaker [   ] Customer
Mold Flow Analysis [   ] Moldmaker [   ] Customer
Cooling Analysis [   ] Moldmaker [   ] Customer
Material Supplied By [   ] Moldmaker [   ] Customer
Accurate Model/s or Master/s By [   ] Moldmaker [   ] Customer
1st Article Inspection By [   ] Moldmaker [   ] Customer
F.O.B. our plant, terms are 1/3 down, 1/3 upon delivery, Date    
1/3 net 30 days, unless otherwise stated in cover letter. Quote #