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Sample Request Form

ANGUS Sample Request Form

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Select a Product^‡

Product Grade:

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Select an Application^‡

Is this sample going to be used in
an evaluation for:

	An existing commercial product
	A potential commercial product

What is the estimated annual volume
of the additive of your product?

When is an appropriate time to
follow-up on your sample evaluation?

	Immediately (within the next two months)
	2‑6 months
	6‑12 months
	No follow‑up requested

If you are not the individual who is going to be working with the sample, please provide us with the name and telephone number of the proper individual so that we may follow-up with them.

First Name

Last Name

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(Include Country/Area Code)

End Use^‡

Are you currently being serviced
through an ANGUS distributor?

	Yes
	No

How should we contact you?

When is the best time to reach you?

Question or Comment?

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Data Privacy and Protection

The information collected in this form will only be used to ensure that we provide you with an appropriate response based upon the information you provide in the form above. We will contact you only if we need additional information to appropriately answer your question or in order to address your need. The contact information you provide, including e-mail address, may be used to respond to your request. We will not use the contact information you provide in this form for product or promotional advertising unless you specifically request to receive product news or information.

For more information, please review our Privacy Policy.