Sample Request Form

Please provide the following data.
RadAddŽ CI-250 sample sizes are 500 grams each.

By submitting this request and receiving sample(s) of the RadAddŽ CI-250, it is agreed that no one, including the person(s), the company, and/or any agent(s) of the company receiving the sample(s), including second parties, shall attempt to analyze and/or disclose the chemical make-up of the said product(s), without prior written consent of Trilogy Group, LLC.

If additional chemical properties information is required, please contact Trilogy Group, LLC.
All efforts will be made to provide the information requested.

*First name*
*Last name*
*Title*
*Company*
	If international, please provide additional data in "comments" below.
*Lab Address*
*City*		State	Zip Code
*Work Phone*
*E-mail*
*Additional Comments*

Or Call (630) 893-8539 for Assistance.
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