Sample Request Form

GS Polymers / Sample Request Form

Name*
Company*
Phone*
Email*
Address*
Street Address Address Line 2 City State ZIP Code
Shipping Address Same As Above:*
- Yes
- No
Will the samples requested be shipped to the same contact address above?
Ship Attention*
Ship Company*
Shpping Address*
Street Address Address Line 2 City State ZIP Code
Ship Method*
- Overnight Air
- Second Day Air
- Ground
UPS Account Number*
Product*
Other

If product is not listed in website product catalog, please enter it here.
Sample Packaging*
- Cartridges
- Small Kit
Side-by-side dual Cartridges which are applied with a mechanical dispenser through a static mix nozzle are available on products with a compatible parts-by-volume mix ratio. Systems without a compatible mix-ratio are sampled in small kits (separate containers) which require weighing and hand-mixing of the components before use.
Amount Requested*

Sample Quantity Requested or Amount Required for evaluation.
Application Description
What type of application would this product be used for?
Additional Info
Additional Information about this request.
Comments
This field is for validation purposes and should be left unchanged.