SAMPLE ORDER FORM

Please provide the following data.  
RadAdd® Samples are typically 4 oz. each.
RadAdd Reactive Silicones are supplied in 100 gm containers.

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

Samples Needed

    INDIVIDUAL SAMPLES   or  LAB BENCH KIT
RadAdd® Defoamer + 
RadAdd® AF200                  Please Send me the RadAdd® Kit   RadAdd® 475                             (contains samples of 6 different products)
RadAdd® 975
RadAdd® 990A
RadAdd® 1024    
RadAdd® 1051                       REACTIVE SILICONES    
RadAdd® 1114                      RadAdd® RS-145
RadAdd® 1116                      RadAdd® RS-230
RadAdd® 1118                      RadAdd® RSM-230
RadAdd® 1126                      RadAdd® RSM-260
RadAdd® 1326
RadAdd® 1327

Special Requests?  Please provide specifics in box below.

Additional Comments


       
If any questions, please contact us at (630) 893-8539 or
                                                                  inquiries@UVadditives.com