Old World Chemicals

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Information/Sample Request Form

* required fields

*Product Sample(s):

Ethylene Oxide
Ethylene Oxide
Monoethylene Glycol
Fiber/Polyester Grade
Antifreeze Grade
Industrial Grade
Diethylene Glycol
Diethylene Glycol
Triethylene Glycol
Triethylene Glycol

Liquid Caustic Soda
Diaphragm Grade (50%)
Membrane Grade (50%)

Deicing Agents
ORD 2000
PEAK PA
PEAK SF

Methanol
Methanol

Shipping Information:

*Your Name:

*Your Company:

*Your Title:

*E-Mail:

*Phone:

Fax:

*Shipping Address:

*City:

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*Country:

*Product Applications:

Please indicate the application(s) for which you intend to use our 
product(s) and any other relevant information that may help us 
determine which chemical product(s) will best fit your needs.

Yearly Volume (tons or lbs):

Comments or Questions:

*Mode of Shipment:

Express (you will be billed for shipping costs):
2nd Day
Overnight--PM Delivery
Overnight--AM Delivery
Your Fed Ex Acct #
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Standard Delivery (Old World pays shipping costs)
UPS Ground--prepaid