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Request A Sample

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Gaylord Chemical can provide product samples to qualified users of chemical products. Please fill out the Sample Request form to initiate the sample request process. To purchase, locate a Gaylord Chemical distributor.

After reviewing your request you may be contacted for more information about your application. Gaylord Chemical Company reserves the right to deny any product sample request. Sample requests will be considered for qualified commercial and research purposes only.

All sample requests are subject to an internal review and individual approval.

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    Product*

    Please list additional information we might need to process your request *

    Region*

    Name*

    First
    Last

    Job Function *

    Phone Number*

    Email Address *

    Company*

    Company Website

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    Address*

    Address Line 1
    Address Line 2
    City
    State/Province/Region
    Postal Code
    Country

    Your Industry*

    General description of your end-use application *

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