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	Please complete the following for a quote on a custom designed product or fax your request to 813-249-1992


	*Name*


	*Company*


	*Address*


	*City*


	*State*

ZIP


	*Phone*


	*Fax*


	*Email*


	*Preferred Method of Contact*


	*Phone*


	*Fax*


	*Email*


	Additional Comments


	Step 1: Choose Port Design


	2 Port Design


	3 Port Design


	Step 2: Choose Size


		38MM (38MM-01 Series)

	48MM (Biotainer Series)


		45MM (1127 Series)

	53MM (53MM Series)


	Step 3: Measurements If you choose the 3 Port design, please continue below to the *3 Port Measurement section*


	*2 Port Design Measurements*


	P1 Length (Cap Side):


	P1 Length (Bottle Side):


	P1:



	P2:


	O.D. x

	O.D. x


	I.D.

	I.D.


		P2 Length (Cap Side):



	P2 Length (Bottle Side):


	*3 Port Design Measurements*


	P1 Length (Cap Side):


	P2 Length (Cap Side):


	P3 Length (Cap Side):


	P1:



	P2:



	P3:


	O.D. x

	O.D. x

	O.D. x


		I.D.

		I.D.

	I.D.


	P1 Length (Bottle Side):



	P2 Length (Bottle Side):



	P3 Length (Bottle Side):


	Step 4: Materials

To complete your request, click on the Send button below and your specs will be sent to J & J Scientific Products and you will be contacted shortly via your preferred method of contact.

Clicking on the Reset button will clear the form and nothing will be sent to J & J Scientific Products.

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