To find out more information about custom grommets, bumpers, gaskets, seals, lab stoppers, crutch tips, and military grommets please print the following form and fax to our home office
Fast Fax 606-789-9098
Quick Response Worksheet
Fax this form to the above number
Mail it to us at: 1437 Ky Rte 1428 Hager Hill, KY 41222 Phone us at: 1-800-GROMMET
Order Standard Parts or Inquire on
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What We Need to Know to Help You:
If Standard Part, Atlantic Part Number:
What is the function of the part?
ASTM CALL Out:
In what temperature range must it operate?
Will it be exposed to ozone, oil, gas, chemicals potable
Must the material be resistant to electricity?
What color and hardness are desired?
What tolerances are required - commercial or precision?
Description of Product Requirements
Standard Shapes
Semi-Standard Shapes Sketch dimensional changes below
Custom Shapes Sketch dimensional changes below
Material Requirement
Other Special Characteristics
Title