Sample Request Form

Please provide the following data.
CureAll^Ž photoinitiator sample sizes are 50 grams each.

By submitting this request and receiving sample(s) of the CureAll^Ž products, 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*
	SAMPLE(s) REQUESTED
	CureAll^Ž 200
	CureAll^Ž 500
	CureAll^Ž 700
	CureAll^Ž 1100
	CureAll^Ž 1500
	CureAll^Ž 2000
*Additional Comments*

Or Call (630) 893-8539 for Assistance.
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