Welcome to the ChemRep, Inc. - Products Order Page

 

Please click on the Order Form below in Adobe Acrobat Format.

ChemRep Order Form.pdf

(Save and/or Print the form and fill out your order.)

 

You may place your order by using the following methods:


Phone us at 800-433-8982.

Fax us at 847-551-9310.

E-mail the filled out form and send it to us at orders@chemrep.com as an attachment.

 

Thank you for your Order!

 

 

 

 

 

 

Example of our Order Form in .pdf Format...

ChemRep, Inc. - Order Form


* (required  fields)

*Company Name:

*Contact Name:

*Email Address:

Phone #:

Purchase Order #:

Ship to:

Address:

City:

State:

Zip:

 

Bill To: (If different)

Address:

City:

State:

Zip:



Product

Unit
Size

# of
Units

Total

Code
(If required)

1)

2)

3)

4)

5)

*Ship VIA (Carrier):

Ship Date:

For Chemlok products a $50.00 up-charge will be applied to orders less than $250.00
or less than a standard case lot quantity of 4 gallons.

Bottom of Form

To Place an Order… Phone us at 800-433-8982 or Fax us at 847-551-9310.
E-mail your Order to orders@chemrep.com and Include your P.O. as an Attachment.

Comments/Special Instructions: