Request a Sample
Name
Title
- Please Select -
Buyer
Consultant
Design Engineer
Manager
Student
Researcher
Other
Company
Address 1
Address 2
City
State / Province
Country
Phone
Contact Information
E-mail
I want IMS to contact me by
Phone
E-mail
Parts to be sampled
If you are unsure about a part number please refer back to product page and data sheet.
Line Item 1
Quantity
Line Item 2
Quantity
Line Item 3
Quantity
Line Item 4
Quantity
Line Item 5
Quantity
Welcome to IMS on-line Request for Samples form. Please fill out all fields so IMS can properly process your request. If you prefer to submit your request by phone fax or email
click here
.
IMS guarentees to respond to all sample requests within 24 hours.
The information you provide will only be used to fulfill your request.
Enter any additional comments or questions in the space below.
Project Information
Please fill out all fields so we can properly process your request.
Please describe the product you will use sample parts in.
Project Type
please select
Prototype
Production Run
Retrofit/ Revision
Hobby
Academic
Project Stage
please select
Bid Level
Pre-contract
Development
Pre-production
Early Production
Full Production
Current or expected production quantities
5 piece max.
5 piece max.
5 piece max.
5 piece max.
5 piece max.
Zip
Samples will ship via U.S.P.S. First Class Mail unless arranged other wise
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