Packaging Sample Request Form

Please complete the following fields to request a sample be made. The more details provided, the better. Required fields are marked with an asterisk. Please include a minimum of 10 – 15 substrates to allow for setup, testing, and final sample runs.

Send samples to:

Engage Technologies Packaging (Eastey/AFM)

Attn: Mike Mellesmoen

7041 Boone Ave. N.

Brooklyn Park, MN 55428

Contact Information

Ship to Address to Return Samples

End User Company Name

Distributor Company Name

End User Contact Name

Distributor Sales Rep Name

End User Contact Email

Distributor Sales Rep Email

End User Company Address

District Sales Manager

End User Company Zip Code

UPS/Fed Ex # (for Expedited Shipping)

End User Company City

Returns Samples to

End User Company State

End User Contact Phone

Industry Served

Description of Application

Film Information

AFM

Film Manufacturer:

Film Type:

Film Gauge:

Film Lay Flat (LFW):

Film Cut Length (CL):

Cut Bands?

FAT Film?

Film Core Size:

Eastey

Film Manufacturer:

Film Type:

Film Gauge:

Film Width:

Other Information

File Upload

Upload any files

Enter your email address to receive a copy

Inbound sample tracking number

Comments

Please print the electronic copy sent to your email and place it in the box when shipping samples to Eastey / AFM.