Request Form for Latin American Labels

Please note that fields with (‡) are required. Please enter N/A if not applicable.

Product Name^‡

Dow GMID^‡

Dow Level 70 Code

Destination Code

	Brazil
	Other LAA Country

Will Product Ship Directly to Dow Customer?

Yes

Is Product Shipped to Dow Latin American Company?^‡

	Yes
	No

If Dow, Legal Name of Dow Company in Latin America

Dow Batch Number^‡

Net Quantity Represented by This Label^‡

Quantity Unit of Measure^‡

Gross Quantity Represented by This Label

Expire Date

Country of Origin^‡

Number of Labels Needed^‡

Requestor Name^‡

Requestor Location^‡

Phone^‡

(Include Country/Area Code)

Date of Request^‡

Date Needed^‡

Dow Cost Center:

Company Code^‡

Plant Code^‡

Cost Center^‡

I would like to order a label using Pro Card.
Please contact me via phone.^‡

Yes

Ship Labels To:

Company^‡

Address^‡

City^‡

State^‡

Zip^‡

Contact Name^‡

Contact Phone^‡

(Include Country/Area Code)

Country^‡

I have a question regarding Latin American labels:

^‡ Required Field

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