EMS Request A Sample

Request for Sample

Our products are available for evaluation purposes. To request a sample, complete the form below and click SUBMIT. All fields marked with an * are required. If you have any questions, please call 1-740-362-4444 or email us at sample@emsadhesives.com.

Ship to Address: (please no post office boxes)

*Company:
*Address:
*Address2:
*City:
*State:		*Zip Code:
*Country:

Contact Information:

*Name:
*Telephone:		Ext:
Fax:
*Email:

Products you are requesting:

Application:

All samples are sent via UPS or Federal Express Ground. If you require faster service please provide a UPS or Federal Express Account number and specify the level of service.

Special Shipping Instructions and Comments:

Samples are sent with the appropriate Technical Data Sheets and Material Safety Data Sheets. Information obtained from our brochures and/or web site is based on data obtained by our own research and is considered accurate. However, no warranty is expressed or implied from the use thereof. This information is furnished upon the condition that the person receiving it shall make his own tests to determine the suitability thereof for his particular purpose.