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Required Information

Requested By:
Date Requested:
Submit To:
Due Date:

Mold Type

Thermoplastic Injection Mold
Number of Cavities
Thermoset Injection Mold
Family Mold
Die Cast Stand Alone
MUD Tool Base
Die Cast Unit Die
JWS Prototype Inserts
JWS 2-Shot Inserts
JWS 3-Shot Inserts

Runner Type

Hot Runner Syst...
Number of Drops
Cold Run
Hot Sprue
Full Round
Runner Shut-O
Cold Slug Well

Side Action

Cam & Pin Lock   
Hydraulic Rack & Pin
Hydraulic Cylinder
Hydraulic Motor
Angle Lifter
Expanding Cavities
Collapsible Core
Floating A-Plate
Auto Unscrewing
Floating B-Plate
Hand Loaded Insert
Not Required


Edge G
Sub Gate
Valve G
Cashew G
Hot Drop To Cold Runner Syst
Fan Gate
Water Cooled Sp
Direct Sprue Intro
Gate Inse
3-Plate Pin Point
Gate Cutter (Edge Gate)
Gates Per Cavity:


Ejector Pins
Spring Loaded Return
Ejector Sleeves
ALBA Couplers Return
Ejector Blades
Accelerated Pins
Stripper R
Pull Hooks
Stripper P
Hydraulic Cylinder
Stripper B
K.O. Bar Extensions
Guided Ejection
Ejector Return Dete
Early Return
Slotted Ejection Pins

Mold Heating & Cooling

Cooling Lines
In Cavity Block
Oil Lines
In Core Block
Cartridge Heat
In Side Actions
In Mold B
Insulator Plates

Mold & Machine Interface Requirements

Est Mold Base Size
(L" X W")
Est Machine Size
# of Machines

Optical Specifications

Tool Will Have Optics
Reflector Optics
Core Optics
Lens Optics
Cavity Optics
Reflex Optics
Cordory Flut
Fresnel Optics
String Lines
Socket Tune Required


Vented Runner
Vent Land Distance
Vented Ejection
Vent DE
Peripheral Venting
Vent Width
Peripheral Channel To Atmosphere
Vacuum Venting Syst
Over Flow Pockets/Tabs

Specific Mold Requirements & Features

Interchangable Inserts
Cyde Counter
Provisions For Transducer
Parting Locks in Mold B
Date Code Inserts
Mold Supplied With Transducers
Specified Cyde Time
Recycling Code Inserts
A Side Part Will Transfer
B Side Part Will Transfer
Micro Switches
Outside Sample
# Parts Reqired

Steel Specification

Polish / Finish
Plating / Coating
Mold Base
Cavity Block
Core Block
Moving Core
Gate / Runner Insert
Vent Insert

Features To Be Inspected

Additional Comments