Sales Enquiry Form

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Customer Details

Company* :

Salutation :

First Name* :

Last Name* :

Email* :

Mobile :

Street :

City :

State/Province :

Zip :

Country* :

Ship to Destination* :

Additional Ship to Destination :

What Industry Are These Gloves Being Supplied To?*

Medical

Dental

Food Service

Industrial

Private Hospital Tender

Ministry of Health

Government Hospital Tender

Cleaning

Others (please specify) :

Any Special Requirements for the Gloves?

1) Any 3rd Party inspection required?:

2) What is the Inspection Agency?(SGS, Intertek, BV, or others?):

3) What is the basis of the inspection (Full ASTM/ Partial ASTM/ EN/ Other)?:

4) Any inspection required by the country's MOH or relevant health authorities like Water Tight Test?:

5) Any standards applicable for these gloves? EN, ASTM or others? Please indicate:

Reason for Sourcing New Supplier *:

Types of Gloves You Are Interested In*:

(Glove Weight is referring to size M)

No.	Type of Glove	Y/N	Weight	Length	Color	Indicative Price (USD)	Remarks
1	Latex Powdered
2	Latex Powder-Free
3	Nitrile Powdered
4	Nitrile Powder-Free
5	Vinyl Powdered
6	Vinyl Powder-Free
7	Latex Surgical Powdered
8	Latex Surgical Powder-Free
9	Nitrile Surgical Powder-Free
10	Latex Household Flocklined
11	Latex Household Polymer-Chlorinated
12	Cleanroom Latex
13	Cleanroom Nitrile
14	CPE
15	TPE
16	Other:

** Please indicate any additional information in the remarks column.
(eg. For Surgical gloves, you may indicate the packing style [Bi-fold / Long-packed / Thermoform] or etc.
For Cleanroom gloves, you may indicate the class, particle count or etc.)

Estimated Volume in Past 6 Months* :

Payment Term* :

Other :

Incoterms* :

Other :

Glove Brand* :

Brand Name :

Other Comments :