Express Media Request Form

Use the form below to request a quote:

Contact Information





Company Information









Product Application

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Product Name/Description


Product Form

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Custom Osmo and PH Specs


Formulation

Please choose from 1 of 3 options below.

(Option 1) If you are re-ordering a previous request, please enter the product number below.


(Option 2) If you are providing a custom formula upload the file or enter it in the field below

File Upload (PDF, PNG, JPG, or GIF)




(Option 3) If you are making a new order, indicate the Irvine Scientific product number below.



Quantity

Order qty for Liquid Products:




OR

Order qty for Powder Products:




Packaging



Quality Control Testing (Optional)

Quality control testing is available upon request at additional cost. Please select all requested tests.

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Label Information

R&D label includes product information, lot number and reads “Non-GMP. For Research Only.” Please provide:



Storage Temperature


Shipping Information

All products ship FedEx® Overnight or equivalent. If requested, products can be shipped with cold packs for an additional charge. Please request cold packs, alternative shipping requirements, or FedEx collect account number below. Note Shipping costs will be determined when order is processed.

Shipping Temperature



Additional Requests/Comments


Request a Quote