Y.E.S. Program Sample Request Form

*All FIRST Robotic teams are eligible for supplier discount only.

*igus® can no longer donate drylin® camera sliders. For school-related projects, a 20% discount is available.

If you do not receive a reply from igus within 48 hours, please contact Catarina Peixoto, for assistance:

Your data:

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:*
Number of students/individuals on team or project:
Advisor/Professor/Mentor Name:*
Advisor/Professor/Mentor e-mail:*
Advisor/Professor/Mentor Mailing Address:
City:
State:
Zip code/ postal code:

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

Internet Search
Engineering competition or website (please specify)
Professor
Other (please specify)

Tell us about your project or design*


How will igus products be used in your design?*


Do you need catalogs?*

Yes
No

Would you like igus® decals?

Yes
No
Number of igus® logo decals:
Number of Y.E.S. logo decals:

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

Yes

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:




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R.I. 02914

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