Polysource LLC

Solutions Provider
to the Plastics Industry

1520 W. Mineral Road
Suite 103
Tempe, AZ 85283
Phone: 480.502.2347
Fax: 480.502.2432

COLOR MATCH / SAMPLE REQUEST

COLOR MATCH / SAMPLE REQUEST
Instructions: Fill out ONE form per product.
For COLOR MATCH, fill out the top portion and boxes 1, 2, and 3
For SAMPLE REQUEST, fill out the top portion and box 3

Company
Requestor Name
Requestor Phone #
Email Address
Product Description
Customer Product Code
Polysource Code (if known)
Special Requirements / Comments

1	2	3
Current Information	Performance Information	Sample/Product Info
End Application	Regulatory Compliance	Product Requested (pick 1)
Standard Enclosed	Additives Required: Type Level	Other
Process
Resin		Sample Size
Melt	Primary Light Source	LDR Requested
Current LDR	Color Tolerance Range	Color Chips
Current Supplier	Exposure	Pellet Size/Count
Processing Temp

For a printable form, please CLICK HERE.