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Sample Request Form: DuPont™ Capstone® Fluorosurfactants

A DuPont Technical Service Specialist will evaluate your desired performance characteristic and intended end-use application, and select the optimum Capstone® fluorosurfactant offering for your needs.

* - required

First Name*Last Name*
 
TitleCompany*
E-Mail Address*
Street Address*
City*State/Province*
Postal Code/ZIP Code*Country*
Phone*Fax
Will the samples or products be used in an agricultural, medical or personal care application?*
Yes    No   
Will samples be used at high temperature (>150°C)?*
Yes    No   
Will respirable particles be generated during the application (<10 microns)?*
Yes    No   
Will sample evaluation be done in a laboratory or controlled location?*
Yes    No   
Does your company follow documented safety procedures for handling and disposing of flammable or hazardous chemicals?*
Yes    No   
 
Do you intend to purchase from a distributor?
Yes    No   
If yes, please specify the distributor:
What is the primary performance characteristic you desire from this sample for your application?*
If other, please specify:
What is the intended end-use application in which this sample will be used?*
If other, please specify: 
 
How did you hear about DuPont Capstone®repellents and surfactants?
 
May we send you occasional eCommunications - including emails and newsletters - about DuPont Capstone® repellents and surfactants?
Yes, add me to your distribution list.