Quote Request: tablets, capsules, liquids, gels, ointments

Quote Request for Contract Manufacturing

50 Toc Drive, Highland, NY 12528 • Phone: 845.691.8361 x110
Fax: 845.691.8360 • Email: contact us via email

Customer Questionnaire

This questionnaire helps UltraSeal/UltraTab evaluate your product and packaging needs. Please have your Quality Assurance personnel or Senior Officer complete this form and submit it to Ultra Tab Laboratories (UTL).

* = required field
UTL = Ultra Tab Laboratories

Contact Information

Company Name ^*

Contact Person ^*

USC/UTL Salesperson

Address ^*

City ^*

State ^*

Zip Code ^*

Telephone ^*

Fax

Your Email ^*

Product Information

Product Name

Is This a New Product?
yesno

Current Supplier

Quantity Per Order

Estimated Annual Volume

Please Explain

Product Questions

Active Ingredient(s) - Please list all ingredients, one ingredient per line.

Inactive Ingredient(s) - Please list all inactive ingredients, one ingredient per line.

Are product samples available to USC/UTL?
yesno

Will samples from UTL be required prior to receiving a quote?
yesno

Tablet/Caplet Characteristics

Dimensions

Length

Width

Thickness

Weight

Cup Depth
StandardDeepExtra Deep

Appearance

Core Color

Tooling Engraving

Coating
UncoatedSugarFilm CoatedEnteric

If coated, color of coating

Powder/Granulation Characteristics

Approximate Mesh Profile

Flow Characteristics

Is humidity a factor in manufacturing?
yesno

If yes, please explain

Ointment/Cream/Gel/Liquid Characteristics

PH Level

Viscosity

Specific Gravity

Color

Clarity

If Cream: Water/Oil Ratio

Is a preservative system required?
yesno

If yes, please identify preservative system or requirements

Special Requirements

Are production samples required; is micro testing required prior to release; etc?

Expiration Dating - Other

Is stability data available to support dating?
yesno

Research and Development

Can you provide a product formula to USC/UTL?

Are manufacturing instructions and/or batch records available to USC/UTL?

Does a development batch have to be manufactured?
yesno

If Yes, size of development batch?

Does the manufacturing process have to be validated?
yesno

Validation: Extended sampling and testing on at least three full-size production batches to verify that the manufacturing process will yield a product that is consistent as related to strength, quality, and uniformity.

Stability Testing

Who will provide stability data for bulk product?
CustomerUTL

Who will provide stability data for packaged product?
CustomerUTL

Finished Product Testing

Who will perform finished product testing?
CustomerUTL

If UTL is performing all finished product testing, what are the criteria for product release?

General Comments

Signed ^*

Title ^*

Date ^*

Authorization *

Accept my name, above, as my signature

Please leave this field empty.

UltraSeal/UltraTab

Ultra Tab Laboratories

Quote Request for Contract Manufacturing

Customer Questionnaire

Dimensions

Appearance

Bottles

Tubes

Packets

Blisters

Folding Carton

Shipper

Raw Material Testing