Product Label Request Form

Request Form for Product Labels: All Countries Label Type What type of label are you looking for? Please Select One: N/A (Not Applicable Bottle Bulk Tag Carton Drum IBC Sample What is the label form number (usually on the back)? Label Data Input What is the Product Name (if known)? What is the GMID (if known)? What is the Level 70 or Trade Product Code (if known)? What is the Batch or Lot number (if applicable)? What is the Net Weight (if applicable)? What is the Gross Weight (if applicable)? What is the Unit of Measure (if applicable)? What is the Country of Origin (what country was the product made in)? What is the Expiration Date (if applicable)? Label Language What country is the product destined for? If label is for a European country - choose either a 3 language or 6 language label (if known):  Three countries on the label  Six countries on the label  Other Indicate Countries: Label Size What label size are you looking for Please Select One: N/A (Not Applicable) 8.5 x 11 8.5 x 14 8.5 x 17 6.5 x 14 6.5 x 18 A4 A5 A7 Bulk Tag - for Laser Output Bulk Tag - for TTR Output Label - Other Considerations List any other considerations required for the label (i.e. color of the tag, etc.)? Distributor Information (if applicable) What is the Distributor name? What is the Distributor address? What is the Distributor phone number?  (Include Country/Area Code) Sales Organization (i.e. selling company if not Dow Chemical): Label Requestor Information Label requestor name? Site or Outplant Location? Email Address?‡ Confirm Email Address?‡ Phone Number?  (Include Country/Area Code) Date of Request? Date labels needed? Dow Cost Center (CC, PC, Cost Center)? Dow Shipment Number? Dow CSR or Zone Outplant Specialist? Label Delivery How do you want your label(s) delivered (i.e. emailed, by delivery vehicle, other)? Printer Information (if requesting an electronic copy of the label): What type of printer will be used (if applicable)? Physical Label Delivery Information - we use FedEx (if requesting physical copy of the label): Quantity of labels desired? Need Date? Ship to information: Company Name: Contact Name: Contact Phone Number:  (Include Country/Area Code) Address 1: Address 2: City State/Province Zip Code/Postal Code Country   Enter the code as it is shown (required):

^‡ Required Field

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