Date of Entry* (Fecha de Entrada)

Client* (Cliente)

Mail* (Correo)

Client Country* (Pais)

Commercial Representative* (Representant Comercial)

Industry* (Industria)
Choose One (Escoge Uno)Packaging (Empaque)Food & Beverage (Alimentos y Bebidas)Building & Construction (Construcción)Automotive & Transportation (Transporte)Textile (Textiles)Consumer Goods (Bienes de Consumo)

Country where the products will be commercialized* (Pais donde se vende el producto)

Is the client willing to pay for antimicrobial technology?* (Industria)
Choose One (Escoge Uno)Yes (Sí)No

Estimated Volume* (Volumen)
A rough estimation is enough which can be in Kg of material, units of products, etc. (Estimado de volumen en kg, material, unidades, u otro.)

Material*
Polymers (PP, PE, ABS...) (Polímeros (PP, PE, ABS...))
Textile (polyester yarn, fabric...), etc (Textil (poliester, tela, etc))

What is the objective of incorporating Copptech in the product?* (¿Cuál es el propósito de incorporar Copptech en el producto?)
Have an antibacterial properties, anti-termites properties, antifungal properties, etc. In aspecific time frame? Which microorganism?
Please provide context to understand the final benefit that Copptech needs to provide.

Short description about the production process* (Descripción sobre el proceso de producción.)

Product requirements* (Requerimientos del producto.)
e.g. maintain color and mechanical properties (Ej. Mantener el color o sus propiedades.)
Are there any samples provided by the client?* (Hay alguna muestra del producto.)Choose One (Escoge Uno)SiNo
Additional Information* (Información Adicional)
Add more information and context if necessary (Agrega más información si es necesario.)
Attachment (Archivo Adjunto)