Y.E.S. Program: Sample Request Form

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Name:*
Phone number:
e-mail:*
School name (no abbreviations):*
Competition or project name:*
Project Deadline or Date of Competition:
Project website (if applicable):
Date Samples Are Needed By:
Shipping address:*
City:*
State:*
Zip code/ postal code:*
Advisor/Professor/Mentor Name:*
Advisor/Professor/Mentor e-mail:*


	Internet Search
	Engineering competition or website (please specify)

	Professor
	Other (please specify)

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Y.E.S. Program Product Request Form

Product Request Form

Your data:

How did you hear about the Y.E.S. Program?*

Tell us about your project or design*

How will igus products be used in your design?*

Do you need catalogs?*

Would you like igus® decals?

Yes, I would like to receive periodic updates through e-mail about the Y.E.S. Program.

How is your project funded? Do you have a budget or must you fundraise / secure parts on your own?*

What products / parts do you need? Please list quantity and / for length of each. List part numbers if you know them:

If you need assistance choosing the correct part(s), please list any relevant technical information and questions here:

Other questions or comments:


	Yes
	No


	Yes
	No

Number of igus® logo decals:
Number of Y.E.S. logo decals: