Republic Packaging's Design Assistance

Please complete the following form for design assistance. Allow 24 hours for us to respond to your need. Some responses may require a telephone conversation. Tell us what you think about your design needs below. We welcome all of your comments and suggestions.

Item to be packaged	Computer Medical Equipment Communications Equip. Other Model:
Fragility G's	1 to 10 G's 11 to 20 G's 21 to 30 G's Other Other:
Weight (lbs)	lbs
Length (in)	in.
Width (in)	in.
Depth (in)	in.
Expected drop height (in)	6" 12" 18" 24" 30" 36" 42" 48"
Test Method:	ASTM 4169 ISTA Company standard Other:
Quantity expected to be shipped:	Per month Per year
Value of Item:	$
Anticipated production start date:	(mm/dd/yy)
Enter any additional comments in the space provided below:
Tell us how to get in touch with you:
Company Name:
Address:
City, St., Zip:
Phone:
E-Mail:
Fax Number:
Attention:
	Please contact us as soon as possible regarding this matter.