BRITANNIA
RUBBER
MFG. LTD.
Since 1984
ISO 9001:2000
Proudly
Canadian
Bill to:
Ship to: (if different)
Company:
Company:
Address:
Address:
City/Province:
City/Province:
Postal Code:
Postal Code:
P.O. Number:
Date:
Ordered By:
Date Required:
Phone Number:
Ship Via:
INSTRUCTIONS:
If you know the stock #, just fill out the quantity, stock #, thickness & width.
Otherwise provide all other details.
If needed in
SLABBED
form (1/4" x 30" x 30"), leave thickness & width
BLANK.
Quantity/Lbs
Stock #
Durometer
Colour
Polymer
Thickness x Width
Select One:
Hypalon
Natural
Neoprene
Nitrile
Nitrile/PVC
Polyurethane
Silicone
S.B.R.
E.P.D.M.
H.N.B.R.
X.N.B.R.
S.E.P.D.M.
x
Select One:
Hypalon
Natural
Neoprene
Nitrile
Nitrile/PVC
Polyurethane
Silicone
S.B.R.
E.P.D.M.
H.N.B.R.
X.N.B.R.
S.E.P.D.M.
x
Select One:
Hypalon
Natural
Neoprene
Nitrile
Nitrile/PVC
Polyurethane
Silicone
S.B.R.
E.P.D.M.
H.N.B.R.
X.N.B.R.
S.E.P.D.M.
x
Select One:
Hypalon
Natural
Neoprene
Nitrile
Nitrile/PVC
Polyurethane
Silicone
S.B.R.
E.P.D.M.
H.N.B.R.
X.N.B.R.
S.E.P.D.M.
x
Select One:
Hypalon
Natural
Neoprene
Nitrile
Nitrile/PVC
Polyurethane
Silicone
S.B.R.
E.P.D.M.
H.N.B.R.
X.N.B.R.
S.E.P.D.M.
x
Select One:
Hypalon
Natural
Neoprene
Nitrile
Nitrile/PVC
Polyurethane
Silicone
S.B.R.
E.P.D.M.
H.N.B.R.
X.N.B.R.
S.E.P.D.M.
x
Select One:
Hypalon
Natural
Neoprene
Nitrile
Nitrile/PVC
Polyurethane
Silicone
S.B.R.
E.P.D.M.
H.N.B.R.
X.N.B.R.
S.E.P.D.M.
x
Select One:
Hypalon
Natural
Neoprene
Nitrile
Nitrile/PVC
Polyurethane
Silicone
S.B.R.
E.P.D.M.
H.N.B.R.
X.N.B.R.
S.E.P.D.M.
x
Select One:
Hypalon
Natural
Neoprene
Nitrile
Nitrile/PVC
Polyurethane
Silicone
S.B.R.
E.P.D.M.
H.N.B.R.
X.N.B.R.
S.E.P.D.M.
x
Select One:
Hypalon
Natural
Neoprene
Nitrile
Nitrile/PVC
Polyurethane
Silicone
S.B.R.
E.P.D.M.
H.N.B.R.
X.N.B.R.
S.E.P.D.M.
x
If you have any questions or comments, please include them in the box below:
ISO 9001:2000 Registered
