Global Region:
* Region Required
Name (Requestor):
Customer (End User):
* Name Required
* Customer/Company Name Required
Salesperson:
Customer Contact Name:
* Salesperson Required
* Contact Name Required
Distributor:
Customer Phone Number:
* Distributor Name or Haeger Direct
* Phone Number Format Invalid
Email Address:
* Email Required
* Invalid Email Format
Other Email Address:
* Invalid Email Format
Other Email Address:
* Invalid Email Format
Description of Tooling Requirements
(Desired type of tooling - Automatic Top Feed, Automatic Bottom Feed, manual, J-Frame, etc.):
* Description Required
Is this tooling for an installed machine?
Is this tooling for a robot-ready machine?
Original Order Number (for replacement parts):
Haeger Model:
* Haeger Model Required
If Other:
MAS Size:
Fastener Information
Fastener Manufacturer:
( 
, PSM, Hank, Kalei, Strux, Captive, Kerb, Konus, etc. - 25 to 300 samples may be required):
* Manufacturer Required
Fastener Part Number:
(If no part number, please attach a signed spec/tolerance sheet):
* Part Number Required
Panel Information
Panel Description:
(Flat, Formed, Reverse flange, to be inserted in the flat, fastener near flange, etc. - part may be required.):
* Panel Description Required
Panel Material:
* Panel Material Required
Additional Information: