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Sample Request Form

The fields indicated by an asterisk (*) are compulsory, other fields are optional.

Section1: Acktar Black Coatings
Acktar coating type (mark the requested type) (*)
Nano Black Magic Black Vacuum Black
Fractal Black Ultra Black
Substrate (mark the appropriate box) (*)
Aluminum Foil / Strip
Thickness (µm):
Length x Width (mm):
With self adhesive backing
Without self adhesive backing
Pre treatment:
sand blasting
other (please specify)
Standard sample size is ~10cm x 10cm
Sheet / Plate
Material:
Covar
Aluminum
other (please specify)
Pre treatment:
sand blasting
plain
other (please specify)
Standard sample size is ~5cm x 5cm
Other (please specify)
Section2: Coating requirements
Optical characteristics (*)
CharacteristicValue %Wavelength range
Reflectance
(specular or diffuse,
incident angle, etc.)
Absorptance
Emissivity
Operating conditions
Abrasion: light moderate severe
Working temperature:
Other:
Description of the intended application & additional requirements
Section3: Shipment information (*)
First name:*Last name:*
Company/Organization:*Title:
Email:*
Phone:
Full shipping address:*
Your organization international account # (FedEx/UPS/DHL/etc.):*
To be filled by Acktar:
Dear customer,
As per your request, please find attached the following samples:
Sample 1
Coating type: ...............................  Substrate material: ...............................
Ref # .................................
Notes .................................
Sample 2
Coating type: ...............................  Substrate material: ...............................
Ref # .................................
Notes .................................

Thank you again for your interest in Acktar's products,
Tel: +972-8-6814-213 x 102     Fax: +972-8-6810-198
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High emissivity black optical coatings, stray light absorption industrial coatings for UV, IR, VIS

© ACKTAR Ltd.1 Leshem St., Entrance A, P.O.B. 8643; Kiryat-Gat , 82000Israel
Phone: +972-8-6814213Fax: +972-8-6810198E-mail: customer-support@acktar.com
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