Part Name: *

Model Name: *

Glasstech Customer: *

Contact: *

Phone Number: *

Fax Number:

E-mail: *

Customer Location: *

Furnace Number: *

Provide the Quantity & Location of All Surface Probes:

Tolerance on All Surface Probes:

Glass Thickness:

Glass Color:

Hole Diameter:

Installation Angle From the Horizontal:

Perimeter Off Form Tolerance:

Acceptable Marking From Edge of Glass:

Perimeter Rate of Change:

Crossbend and Tolerance (SAG):

Fracture Standard:

Number of Samples That Will Be Required To Be Produced During Prove Out: