SAMPLE REQUEST/INQUIRY FORM
* = required fields.
*Literature or samples?
Literature
Samples
Both
None (Feedback about web site)
 
What types of products are you interested in? (Desired properties)
 
If you can specify our product(s), please type.
1.
2.
3.
4.
5.
 
Tell us how to get in touch with you.
*Your name:
*Company:
*Street Address:
*City:
*State:
*Country:
*Zip Code:
*Your E-mail:
*Tel:
Fax:
Please contact me as soon as possible regarding this matter.
 
If possible, please fill out below.
Potential quantity per month KGS
How long do you need for your evaluation? Weeks
What kind of tackifier(s) are you using now?
 
Enter any other comments in the space below:
 
 

GO BACK TO HOME


Copyright 2002 Arakawa Chemical (USA) Inc. All Rights Reserved.