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| 1. |
Trade Name *
Trade Name is a required field, please specify
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Generic Name
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| 2. |
Manufacturer*
Manufacturer is a required field, please specify
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Address*
Address is a required field, please specify
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City*
City is a required field, please specify
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Patented?
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State*
State is a required field, please specify
Zip Code*
Zip Code is a required field, please specify
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| 3. |
Background description of company and its products* |
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Description is a required field, please specify
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| 4. |
Recommended Uses-Primary*
Primary Category is a required field, please specify
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Note: Categories with asterisk (*) require NTPEP Submittal. Vendor needs to obtain NTPEP Test results before submitting product to KYPEL.
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| 5. |
Recommended Uses-Alternate
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| 6. |
Outstanding Features or Advantages Claimed* |
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Outstanding Features is a required field, please specify
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| 7. |
General Composition of Material (Send Lab Report When Applicable)* |
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Material Composition is a required field, please specify
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| 8. |
Date introduced on Market*
Introduced Date is a required field, please specify
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Alternate for What Existing Product?
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| 9. |
Cost Per Unit Material? (F.O.B.) $
Cost Per Unit input is invalid. It should be decimal number, only
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Royalty Cost? $
Royalty Cost input is invalid. It should be decimal number, only
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| 10. |
Cost Per Unit in Place? $
Cost Per Unit In Place input is invalid. It should be decimal number, only
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| 11. |
Material Specifications Furnished by Manufacturer?
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| 12. |
Product Availability:
Delivery at Site Within
Days after Receipt of Order
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| 13. |
Can Samples Be Provided?
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Free
Or at Cost: $
For Laboratory Testing?
Cost for Lab input is invalid. It should be decimal number, only
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Free
Or at Cost: $
For Field Evaluation?
Cost for Field input is invalid. It should be decimal number, only
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| 14. |
Does product meet requirements of following specifications? (Give Specification No.) |
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AASHTO
ASTM
Fed. Spec.
KY
Others
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| 15. |
Has product, or is product being evaluated by other Highway authorities or other agencies? (State by Whom) |
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| 16. |
Is product approved for use by other highway authorities or other agencies? (State by whom used and whether use is routine or experimental only and attach documentation (if available.) |
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| 17. |
Has another office of the Kentucky Department of Highways been contacted?
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Which office?
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When?
The Date format is not correct. Please pick up a Date from calendar icon, or input a date format similar to one created from picking up action.
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| 18. |
Product web page:
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* Required Fields |
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Product Submitter's Information:
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Name: *
Authorizing Agent is a required field, please specify
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Filling Date:
Fri, 13 May 2016 12:47:19 -0400
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Organization:
Hanes Geo Components
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Address:
815 Buxton Street, Winston Salem, NC 27101
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Telephone Number:
888-239-4539
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Email Address:
Email is a required field, please specify
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