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Company
Address
User Contact
Phone No.
FAX No.
DATE
Required Date
Shipping
Press Model No.
No. of Stations
Tooling Size
Punch Mat.
Die Mat.
Availability of Samples
Upper Tablet Face Dwg. No.
Lower Tablet Face Dwg. No.
Upper Punch (quantity)
Lower Punch (quantity)
Tablet Shape/Size (check one)
DIM. A
DIM. B
Tablet Profile (check one)
Cut Depth C=
Land= 
Bevel Angle=
Tool Head Requirements
Die Quantity
DIE INFO.
Die Goove Protection
Tapered Dies 
(+.003 on Dia. 3/16 Deep)
EXTRA OPTIONS
KEYS
Embossed
Plain
Bisect 
Embossed
Plain
Bisect 
Round
Capsule
Modified Capsule
Oval
Square
Other
Flat Beveled Edge
Convex
Convex Bevel
Compound Cup
Flat Faced
Ball
Other
T.S.M. Head
Special
T.S.M. Semi-Domed
1 End
2 Ends
Woodruff with Screw
Hi Pro
Fixed Parallel 1 Side
E-mail
Fixed Parallel 2 Sides
Tooling ReplacementNew
Tooling ReplacementNew