Print Sample Request Form Piezo, TIJ, DOD

Please complete the following fields to request a print sample on your substrate. The more details provided, the better. Required fields are marked with an asterisk. Please include 10 – 15 substrates to allow for ink testing, setup, and print sample runs.

Send Piezo, TIJ, DOD samples to:

Squid Ink

Attn: Print Sample Lab

1173 Osborne Road

Spring Lake Park, MN 55432

Distributor Company Name

Distributor Sales Rep Name

Distributor Sales Rep Email

Squid Ink District Sales Manager

Returns Samples to

Account # (if Expedited Shipping is being requested)

Ship to Address to Return Samples

End User Company Name

End User Company Address

End User Contact Name

End User Company City

End User Contact Phone

End User Company State

End User Contact Email

End User Company Zip Code

Type of Printer Desired

CoPilot	CoPilot 128
CoPilot 256	CoPilot 500 Turbo
CoPilot Max Turbo	CoPilot Max LT Long Throw
CoPilot Max 512i Turbo	CoPilot Gemini
Viper TIJ	SQ/2
SQ/2 Scorpion	Vector XII

Specify Printhead

Print Location on Product

Substrate Description

Substrate Temperature (In °F)

Product Environment

Clean	Condensation
Dry	Dusty
Frozen	High Humidity
Retort	Washdown/Wet

Code Durability/Performance Conditions

Abrasion	Refrigerated/Frozen
Scratch Test	Sunlight/UV Fading
Tape Test

Environment Temperature (In °F)

Line Speed (In FPM)

How much time before code is touched (Minutes)

How much time before code is touched (Seconds)

What method of drying is preferred

Ink Number Requested (add ink number or description)

Message to be Printed

Message to be Printed (attach image)

Multiple Attachments?

Select the box to add more attachments

Other Attachments

Message to be Printed (attach image 2)

Message to be Printed (attach image 3)

Message to be Printed (attach image 4)

Message to be Printed (attach image 5)

Message to be Printed (attach image 6)

Message to be Printed (attach image 7)

Additional Comments

Enter your email address to receive a copy

Inbound sample tracking number

Please print the electronic copy sent to your email and place it in the box when shipping samples to Squid Ink.

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