Gasket Quote Form

Please provide answers to the items to ensure we are quoting exactly what the customer needs. This information will remain internally at Southern Rubber and will be utilized by our quoting team. This information will be considered proprietary and will not be shared with anyone outside of our company.

Contact Information

Name(Required)

First Last

Company(Required)

ESP/SRC Contact

Email(Required)

Date Required

Details

Material

Desired Color

Adhesive

Drawing Provided

Please Select One

Solid (Durometer needed)

Sponge (Density needed)

Durometer (If Solid Selected)

Density (If Sponge Selected)

Application

Estimated Annual Usage

Target Price

Order Type

One Time

Recurring

Temperature/Pressure

Temperature Range (F°)

Pressure Range (psi)

Additional Information

Any Exposure? (UV, gasolines, synthetic hydraulic fluid etc.)

Any Special Requirements? (packaging, shipping, PPAPs, etc.)

Any Other Helpful Information?

Meeting

Would you like to meet with Southern Rubber application team?

Yes