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Contact Information
*Name:
*Company:
*Email:
Address:
*Phone #:
Ext.
City:
State:
Zip Code:
*indicates Required Field
Project Name :
Resin Type/Make:
Part Name:
Est. Part Weight (g):
CAD Number(s):
Shrink Rate (in/in):
Drawing Number(s):
Mold Machine Type:
Revision Level(s):
Machine Tonnage:
Number of Cavities:
Tie Bar Dimensions:
Est. Parts/Year:
Min/Max Mold Height:
Mold Type
Mold Specification
Mold Construction
Injection
SPI Class 101
Conventional
Horizontal Press
SPI Class 102
3-Plate
Vertical Press
SPI Class 103
Stripper Plate
Two Shot Mold
SPI Class 104
Insulated Runner
Vertical Injection
S.A.E.
Runnerless
Metric
Reverse Injection
Supplier to Advise
M.U.D. Insert
Other (specify below)
Stack Mold
Hand Load Inserts
Supplier to Advise
Mold Base
Mold Base Material
Core Material
DME
SAE 1030
420 S.S.
Hasco
AISI 4130; 28-34 Rc
P-20
M.U.D.
P20; 29-36 Rc
H-13
Custom Made
Stainless Steel
S-7
Other DME Equivalent
Aluminum
Ampcoloy Insert
Supplier to Advise
Nickel Plated
Beryllium Copper
Chrome Plated
Other (specify below)
Other (specify below)
Supplier to Advise
Cavity Material
Surface Finish (cavity)
Surface Finish (core)
420 S.S.
SPI Finish
SPI Finish
P-20
EDM
EDM
H-13
Mold-Tech #
Mold-Tech #
S-7
Plated
Plated
Ampcoloy
See Drawing
See Drawing
Beryllium Copper
Other (specify below)
Supplier to Advise
Hardness
Gate Type
Runner
Cavity
Core
Edge gated
Full Round
None Specified
Sub gated into part
Trapezoidal
Pre-Hard
Sub gated into pin
Hot Runner
Hardened
Pin gated
Brand
48-52 Rc
Gate Inserts
Size (specify below)
54-58 Rc
Center Sprue
Other (specify below)
Supplier to Advise
Loc (specify below)
# per Part
Sprue Bushing
Ejection
Slide Action
Standard
Ejector Pins
Mechanical
Cooled
Ejector Blades
Hydraulic
Hot; Type
Ejector Sleeve
Air Cylinder
Custom
Stripper Plate
Lifters
Locator Ring
Air
Cam Actuated
Supplier to Advise
Early Ejector Return
Angle Lift
Lifter
Collapsable Core
Two Stage Ejection
Positive Return
Other (specify below)
Ejection Activated
Supplier to Advise
Not Applicable
Screw Mechanism
Cooling/Heating
Rack and Pinion
Mold Base
Recessed Water Fittings
Gear Motor
Core
Thermal Pins
Spindle
Cavity
Thermocouple
Auto Hydraulic
Blocks
Hot Oil
Manual
Water manifold
Water
Other (specify below)
Clamping Plates
Other (specify below)
Supplier to Advise
Insulator Plates (HR only)
Supplier to Advise
Not Applicable
Misc. Features
Guided Ejection
Cycle Counter
Limit Switches
Push/Pull Ejector Box
Recycle Logo
Pry Bar Slots All Plates
Progressive P.L. Lock (4 on CL)
Latch Locks
Clamp Slots, 4 sides
Taper Locks
Flash Chrome Plating
Break All Edges
Spring Loaded Ejectors
Mold Straps
Ejector Pins Timed
Recessed Jiffy Connect
Date Indicators
Ejector Pins Labeled
K.O./Adapter Flush to Platen
Pressure Sensors
Other (specify below)
Must Run Automatic
Threaded Ejector Bars
Nickel Plating
Eye Bolts, 4 sides
Bronze Lamina Plates
Nitrited Core Pins
Hand Load Inserts
Spare Components
File Exhange Format
Brass Insert
Sleeves
Pro/E Part Files
Steel Shaft
Gate Inserts
Pro/E Drawing Files
Over Molded
Core
IGES Surface Files
Other (specify below)
Cavities
IGES Drawing Files
Not Applicable
Ejector Pins
DXF Drawing Files
Hand Load Inserts , #
SolidWorks
2 Heater Elements (HR only)
Other (specify below)
2 Thermocouple (HR only)
Mold Design
Mold-Maker
B.O.M.
Customer Supplied
Supplier to Advise
Detailed Design
Thermo Analysis
Conceptual Design
Mold Flow Analysis
Layout Design
Mold Samples & Data
Sample Parts Required
Misc. Requirements
Specify Other requirements here.
Material Supplied by ?
Material Supplied by Supplier
First Article Report Required
Weekly Progress Reports
Additional Notes/Questions:
Copyright 2012 Liberty Molds, Inc. • 8631 Portage Industrial Dr., Portage, MI 49024
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