Chemicals Quote

Fill out the form to request a quote for your custom chemicals. Not sure what you need? Contact a Fisher Scientific™ Sales Representative to learn more.

Sales Rep / Chemical Area Manager Contact Information

Sales Representative Name:

Sales Representative Phone:

Sales Representative Email:

Global Chemical Area Manager Name:

Account Information

Company Account Name:

Customer Contact Name:

Account Number:

Address:

City:

State/Province:

ZIP/Postal Code:

Phone:

E-mail:

Product Information - For All Inquires

Catalog Number :

If no catalog number is available, please provide chemical name / CAS number, and Grade

CAS Number :

Chemical Name :

Grade :

Specify documentation and controls required if needed :

TPP (Third Party Procurement) :TPP signifies no labeling, testing or packaging by Fisher.

Market Segments - required for all non-catalog requests

Please select one of the following:

Application, if known:

How many units should we quote on? (i.e. 5, 10, 100, multiple volumes)

Package Size and Unit: (i.e. 50 KG, 4 Liter)

Annual Usage:

Should we quote on the annual usage?

Has the customer performed any pre-evaluation or sampling of our Global Chemicals material?

If Yes – please provide part number and lot number

Current Supplier:

Current/Target Price:

Additional Information - For Specialized Services Only

Testing Requirements :
(or you may attach as a separate attachment)

Custom Blend Requirements W/W, V/V, W/V, and Tolerance Range for each component :

Component 1

Component 2

Component 3

Any Relevant Additional Information :(or you may upload as a separate attachment)

Do you need to know the number of pallets that will be used for Deduct and Hold (D&H)?

Fisherpak Requirements

FisherPak:

Tote (stainless steel): 1350li

Other Size:

NowPak2 (steel outer drum):

19L size only

Required number of drums/totes
@ customer (at 1 time):

Number of dispensing points :

Is additional Fisherpak Hardware needed :
for example:("Autovalve")

SOP-8000 (A) - Attachment 1 SCS Quotes Request Form