Request a Sample: Permalac

You may use this form to submit a request for a sample of Permalac. Please know that up to 2 samples of Permalac are free. If you want to get more than 2 samples of Permalac, anything beyond the first two will be charged at 50% of the cost, plus shipping on all samples.

Date*
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Name*
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Phone*
Company Name*
Billing Address*
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Shipping Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Which Products?
Description of Item/Product Number and Quantity*
Description of Item/Product Number and Quantity*
Payment for Sample: Shipping Account or Credit Card?*

If you already have a shipping account with UPS or Fedex, please provide it in this field. We will bill your sample shipping directly to that account. If you do not have a shipping account and would like us to ship it the best way, you will be responsible for paying the shipping. If you have chosen extra samples (more than 2), you will also be responsible for paying for those at 50% cost. For this option, we accept credit card payment. To use a credit card, please type "credit card" in the field and click "submit". Once we receive this sample request, we will follow-up shortly and send you a credit card authorization form or secure payment link to capture the payment information to proceed with the order.
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Request a Sample: Permalac

Which Products?

Title