Territory Managers


  Tell Us About Your



Northeast Industrial Sales, Inc.
(518) 965-5375     info@nisinc.net
PO Box 370
Ghent, NY 12075-0370

Adhesives and Sealants ☼ Coatings ☼ Dispensing Equipment

Application Survey

Please tell us about your Waterproofing, Restoration, Cleaning, Corrosion Prevention, Spill Control, Dispensing, Cutting, Sealing or Bonding Application in detail..

 Part I.
Your Application Detail: (please be as descriptive as possible)

  If you require an adhesive for a bonding application please complete Part II of this survey.  If not, go directly to Part III to finish and submit.

 Part II.
What substrates are being bonded?  Please be specific.
   I am bonding to

 Is this a production application?
   If yes, what is your projected annual usage?

 Is this a new application?
   If no, are you currently using an adhesive for this application?
   If yes, what are you using?

 Does this adhesive perform to your expectations?
   If no, what could be improved?

 Do you require a structural bond?

 Do you have a preference for any specific adhesive system?
  (to make multiple selections, hold down the CTRL key on your keyboard while you click each choice)
   If other, please specify.

 Part III.
Please provide the following information and submit this Application Survey.  You will
 be contacted within one (1) business day to review this application in more detail or to
 suggest a suitable product for your requirements. 


 Company Name

 Phone Number   Ext.

 Cell Phone

 E-mail Address

 Your Location

 How do you prefer to be contacted?
  Regular Phone    Cell Phone     E-mail


To order a sample or locate a stocking Distributor for any of our products, please call 518-965-5375 or email your request to us by clicking HERE.

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