Heat Transfer Fluid Sample Test Kit Order

Heat Transfer Fluid Sample Test Kit Order

Please fill out a separate form for each fluid sample.

Have you registered your system with CORECHEM? Follow this link and register now for assistance with tracking and maintaining the fluids.

CORECHEM Unique System Identification# (if available)*

This is found in the bottom left corner of the CORECHEM system label. Type "N/A" if there is no number available.

Company Name*

Contact Name*

Phone No.*

Phone

Email*

Project Name*

Project Address, City, ST ZIP*

Note the location of the system installation here.

Do you need a kit shipped or are you shipping your own packaging?*

VERY IMPORTANT: Unlabeled or leaking packages WILL NOT be accepted for testing.

Select

Shipping Address, City, ST ZIP*

Enter the address you would like the Test Kit shipped to, if different from the Project Address above. If the same, please note "SAME".

If you already have the kit in your possession or you are shipping your own packaging, please note "N/A".

Product*

Select or enter value

Your Reference No. (Optional)

Requested Ship date*

What day would you like CORECHEM to ship the test kit? Allow for transit time from Knoxville, TN. Default is 1-3 days from receipt of this order.

Comments

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