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1 Inquiry Creation
2 Recipient Info
3 Requestor Info
4 Review & Submit

1 Inquiry Creation
2 Recipient Info
4 Review & Submit

How can we help you?

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Product Information

Select a product, or add a new one.

Please enter a single product name.*

Product Name

Sample Quantity*

Unit of Measure (e.g. KG, LBS, Drums, Cartridges)*

I need Samples from multiple batches

Estimated Annual Purchase Volume*

Unit of Measure (e.g. KG, LBS, Drums, Cartridges)*

Sample Request Details

Priority*

Standard Rush

Courier Name*

Courier Number*

Requested Delivery Date*

If Sample is being received by someone in the European Union (EU), please provide the Value Added Tax (VAT) number as applicable.

Market*

Submarket*

Application*

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Please enter the details of your request

Literature

Select a product, or add a new one.

Please enter a single product name.*

Product Name

Safety Data Sheet

Certificate of Analysis

Lot Number or Dow Order Number*

Sales Specification

Technical Data Sheets

ISO Certificate

Other

Please enter the details of your request.*

Market*

Submarket*

Application*

Pricing and Availability

Select a product, or add a new one.

Please enter a single product name.*

Product Name

Estimated Annual Purchase Volume*

Unit of Measure (e.g. KG, LBS, Drums, Cartridges)*

Market*

Submarket*

Application*

Registration, Evaluation, Authorization of Chemicals (REACH)

Select a product, or add a new one.

Please enter a single product name.*

Product Name

REACH Registration

Substances of Very High Concern

Please enter the details of your request.*

Market*

Submarket*

Application*

Technical, Regulatory, or Other Inquiry

Select a product, or add a new one.

Please enter a single product name / technology or market / application.*

Product Name

Please enter the details of your request.*

Market*

Submarket*

Application*

Current Requests:

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Inquiry Fields

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NO DOCUMENT ATTACHED!

Supported file types: .doc(x), .ppt(x), .xls(x), .jpg, .gif, .png, .pdf, .zip

Size limit: 8 MB
(Note: You can only add one file per submission. If multiple attachments are needed, please place in a single .zip file before attaching.)

Recipient Information

Requestor Information

Before we submit your request, we need additional information about you.

Who is this request for?*

I'm requesting product information or samples for myself

I'm requesting product information or samples for another person/party

Salutation

First Name*

Last Name*

Email*

Confirm Email*

Opt in to email for News & Events from Dow

Phone*

Mobile Phone

Company*

Country/Region*

Address Line 1*

Address Line 2

City*

State/County/Province*

Zip/Postal Code*

Fulfillment Consideration

Is this inquiry for a Dow Silicones product?*

Yes No

Who should receive fulfillment communications?

Requestor

Recipient

Provide any additional email addresses that should receive fulfillment communication:

Please fill in all required fields

Review your submission

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Inquiry Fields

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Fulfillment Consideration

Is this inquiry for a Dow Silicones product?*

Yes No

Who should receive fulfillment communications?

Requestor

Recipient

Provide any additional email addresses that should receive fulfillment communication:

Recipient Information - Edit

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Requestor Information - Edit

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Supporting Documentation - {{ fileAttachment ? '' : '+ ' }} {{ fileAttachment ? 'cig.change.document' : 'cig.attach.document' | i18n }} Delete

{{fileAttachment.name}} ({{fileAttachment.size | b2mb}} MB)

NO DOCUMENT ATTACHED!

Supported file types: .doc(x), .ppt(x), .xls(x), .jpg, .gif, .png, .pdf, .zip

Size limit: 8 MB
(Note: You can only add one file per submission. If multiple attachments are needed, please place in a single .zip file before attaching.)

Supported file types: .doc(x), .ppt(x), .xls(x), .jpg, .gif, .png, .pdf, .zip

Size limit: 8 MB
(Note: You can only add one file per submission. If multiple attachments are needed, please place in a single .zip file before attaching.)

Please fill in all required fields

Thank you

Hi {{requestingUser.firstName.value}},

We have received your request for:

{{inquiry}}

A confirmation email has been sent to {0} with a copy of what you have submitted from info@dow.com. If you do not see an email check your junk folder.

{{email}}

If you do not see an email, check your junk folder

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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.

Contact Us

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Product Information

Sample Request Details

Literature

Pricing and Availability

Registration, Evaluation, Authorization of Chemicals (REACH)

Technical, Regulatory, or Other Inquiry

Current Requests:

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Inquiry Fields

{{getProductById(product.id).name}}

Recipient Information

Requestor Information

Fulfillment Consideration

Review your submission

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Inquiry Fields

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Fulfillment Consideration

Recipient Information - Edit

Requestor Information - Edit

Supporting Documentation - {{ fileAttachment ? '' : '+ ' }} {{ fileAttachment ? 'cig.change.document' : 'cig.attach.document' | i18n }} Delete

It’s not too late to create your account for {{requestingUser.email.value}} and enjoy more:

Data Privacy and Protection