P&G Chemicals Sample Request Form

Before you send your request, we would like to explain how we use your personal information and why it’s as important to us as it is to you.

For P&G to be able to help you, we and our trusted service providers may collect your personal details. Your details will be stored for a period of time in line with legal and regulatory requirements depending on the nature of your inquiry.

How we use the details you provide:

To respond to you and send relevant items or to follow up regarding your request

To report data to regulatory authorities as may be required by law

To identify trends in data that help us improve our products and services

To read P&G's Privacy policy please visit https://www.pg.com/privacy/english/privacy_statement.shtml

Sample Request Information

Region

Requester Information

Who is requesting the sample?

Requester Name

Requester Role

Requester Company

Requester Phone #

Requester Email Address

Requester Street Address

Requester Address 2

Requester Address 3

Requester City

Requester State/Territory (USA and Canada only)

Requester Zip Code

Requester Country

Age Verification

By Checking this box I verify that I am at least 18 years of age.

Shipping address is the same as requester address?

YesNo

Shipping Information

Who is evaluating the sample?

Attention To Full Name

Receiver Role

Receiver Company

Receiver Phone #

Receiver Email Address

Receiver Street Address

Receiver Address 2

Receiver Address 3

Receiver City

Receiver State/Territory (USA and Canada only)

Receiver Zip Code

Receiver Country

Products

New Product

Qualification Timing