Sample Requests

Please fill out the following form to request product information or a product sample from PeroxyChem. Upon completion, you will receive an email confirmation and we will contact you to confirm the details of your request.

Please note: Lead time, once the request has been approved, is approximately 10 business days plus transit time. We are unable to ship to a PO Box. A sample fee may be charged.

Your Information

Company Information

Shipping Information

Same as Company Information

Billing Information

Same as Shipping Information

Additional Information

Additional Information

Additional Information

Additional Notes