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SAMPLE TRACKING FORM
ArroChem Incorporated - The First Choice For Specialized Industrial Chemicals



This online form helps us track sample results to better serve our customers.

If you have requested a sample from Arrochem, please answer as completely as possible and press the "Submit" button to forward the information to us.

Items marked with a "*" are required.

* What is your name?

* What is your email address?

* What is the name of your company?

* Which product(s) did you request?

Did you receive your sample within 1 week of requesting it? Yes        No

Have you had the opportunity to test the sample? Yes        No

If you tested the sample, how were the results? Great Adequate Inadequate

Do you plan to purchase this product in the future? Yes       No       Maybe

Do you think the product is a good value at the price quoted? Yes       No
I Didn't Receive a Quote

How can we be of further assistance?