Product Sample Request Form Name* First Last Company* Phone*Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Request a Sample from One of the Following Categories:*EMIPolyfabThermalEMI Product Samples Fabric Over Foam Gaskets Fabric Over Silicone Gaskets DynaGreen® / DynaShear GreenShield Gaskets Conductive Foam ORS-II Elastomers Absorber-BandSorb® Conductive Tapes I/O Shielding Gasket Environmental / EMI Shielding Shielded Windows Vent Panels BeCu Fingerstock PolyFab Product Samples Foam Seal SillGuard TPE Seal PP Seal Dual Extrusion Seal Thermal Product Samples Gap Fillers Phase Change Insulator Conductive Thermal Grease Thermal Putty Tell us about your application:* = Required Field