Valvic II Inc.

Valvic II Incorporated
P.O.Box 611
Flemington, NJ 08822

Tel: (908) 782-8400
Fax: (908) 782-2031
sales@valvic.com

The following is a brief inquiry form to allow us to better serve you. You may either
1) Fill out the online form and click send OR
2) Print out the page and fax or mail it to our sales associates.

Name*

Company*

Phone*

E-mail*

Please let us know how we can help you:

If you would like to fill out a more detailed request, please submit the information below:

Product Name

Part Number

Annual Quantity

Mold Available	Yes	No
If no, quote on new mold?	Yes	No

Mold Dimension

Cavitation

Inserts Furnished by	Valvic	Customer
Sample Available	Yes	No

Material

Durometer

Function

Environment

If you have any questions about this form, please contact
sales@valvic.com

* required information

If you like, you can also print and mail the form to:
Valvic II, Incorporated, P.O. Box 611, Flemington, NJ 08822
or fax it to 908-782-2031