Contact Information

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if other please describe

What size/how often do you purchase high-quality cleaners?

Single boxes or bottles

Units

-

+

Boxes or bottles

Cases

-

+

50-100 lb or 5-15 gal drum

Medium Sizes

-

+

300 lb or 55 gal drum

Bulk Sizes

-

+

Estimated annual purchases of high-quality cleaners, if known

if other please describe

What type of cleaner do you use?

Type of Cleaner used

Liquid cleanerPowder cleanerI can use either powder or liquid

If you clean by immersion, how?

If Other Method:

describe other non-spray

What machine cleaner do you use?

Is there an acid rinse cycle?

NoYes

Cleaners

If no, what do you use?

Are you are currently experiencing problems with the cleaner you are using?

Any special waste treatment/disposal concerns?

Is rusting an issue?

yesno

Additional comments

Are you willing to receive hazardous corrosive liquid detergent samples if the questionnaire indicates that they should be tested for your application?

No, please do not send hazardous corrosive liquid detergentYes, we can receive hazardous corrosive liquid detergent

Special complimentary book offer - $39.95 value - The Aqueous Cleaning Handbook

I agree to try the samples being sent as a result of this request

I agree to let Alconox know the results of my sample trial by completing the sample report card (will be included with samples)

I understand that I will be billed $39.95 for the book if I fail to try out and report the results of my trial

Please SEND me the Aqueous Cleaning Handbook. I agree to terms stated above.