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The below form allows you to request as many products as you like. View our full <a href="https://www-americanelements-com.translate.goog/quote?_x_tr_sl=en&_x_tr_tl=nl&_x_tr_hl=en#contactinfo">contact information</a> below.</p> <p>A sales engineer will respond with cost and delivery immediately from our local offices in several time zones. We accept all forms of payment and currency and all major credit cards. American Elements provides payment terms for bulk orders and term contracts based on your good credit.</p> </div> <fieldset class="webform-component-fieldset webform-component--product-information form-wrapper"> <legend><span class="fieldset-legend">Product Information</span></legend> <div class="fieldset-wrapper"> <div class="form-item webform-component webform-component-textfield webform-component--product-information--product-name"><label for="edit-submitted-product-information-product-name">Product Name <span class="form-required" title="This field is required.">*</span></label> <input required type="text" id="edit-submitted-product-information-product-name" name="submitted[product_information][product_name]" value="" size="40" maxlength="128" class="form-text required"> </div> <div class="form-item webform-component webform-component-textfield webform-component--product-information--product-code"><label for="edit-submitted-product-information-product-code">Product Code </label> <input type="text" id="edit-submitted-product-information-product-code" name="submitted[product_information][product_code]" value="" size="30" maxlength="128" class="form-text"> </div> <div class="form-item webform-component webform-component-textfield webform-component--product-information--cas-number"><label for="edit-submitted-product-information-cas-number">CAS Number </label> <input type="text" id="edit-submitted-product-information-cas-number" name="submitted[product_information][cas_number]" value="" size="40" maxlength="128" class="form-text"> </div> <div class="form-item webform-component webform-component-textfield webform-component--product-information--iupac-name"><label for="edit-submitted-product-information-iupac-name">IUPAC Name </label> <input type="text" id="edit-submitted-product-information-iupac-name" name="submitted[product_information][iupac_name]" value="" size="60" maxlength="128" class="form-text"> <div class="description"> (optional) </div> </div> <div class="form-item webform-component webform-component-select webform-component--product-information--purity"><label for="edit-submitted-product-information-purity">Purity </label> <select id="edit-submitted-product-information-purity" name="submitted[product_information][purity]" class="form-select"><option value="" selected>- None -</option><option value="TG">Technical Grade</option><option value="018">98%</option><option value="02">(2N) 99%</option><option value="025">(2N5) 99.5%</option><option value="03">(3N) 99.9%</option><option value="035">(3N5) 99.95%</option><option value="04">(4N) 99.99%</option><option value="045">(4N5) 99.995%</option><option value="05">(5N) 99.999%</option><option value="06">(6N) 99.9999% (check availability)</option><option value="07">(7N) 99.99999% (check availability)</option><option value="01">Other or N/A</option></select> <div class="description"> Select the purity closest to your requirements. </div> </div> </div> </fieldset> <fieldset class="webform-component-fieldset webform-component--product-details-nano form-wrapper"> <legend><span class="fieldset-legend">Product Details</span></legend> <div class="fieldset-wrapper"> <div class="form-item webform-component webform-component-radios webform-component--product-details-nano--target-type"><label for="edit-submitted-product-details-nano-target-type">Target Type </label> <div id="edit-submitted-product-details-nano-target-type" class="form-radios"> <div class="form-item form-type-radio form-item-submitted-product-details-nano-target-type"><input type="radio" id="edit-submitted-product-details-nano-target-type-1" name="submitted[product_details_nano][target_type]" value="1" checked class="form-radio"> <label class="option" for="edit-submitted-product-details-nano-target-type-1">Disc </label> </div> <div class="form-item form-type-radio form-item-submitted-product-details-nano-target-type"><input type="radio" id="edit-submitted-product-details-nano-target-type-2" name="submitted[product_details_nano][target_type]" value="2" class="form-radio"> <label class="option" for="edit-submitted-product-details-nano-target-type-2">Rectangular Plate </label> </div> <div class="form-item form-type-radio form-item-submitted-product-details-nano-target-type"><input type="radio" id="edit-submitted-product-details-nano-target-type-3" name="submitted[product_details_nano][target_type]" value="3" class="form-radio"> <label class="option" for="edit-submitted-product-details-nano-target-type-3">Rotatable </label> </div> <div class="form-item form-type-radio form-item-submitted-product-details-nano-target-type"><input type="radio" id="edit-submitted-product-details-nano-target-type-4" name="submitted[product_details_nano][target_type]" value="4" class="form-radio"> <label class="option" for="edit-submitted-product-details-nano-target-type-4">Other (Please describe in Additional Information) </label> </div> </div> </div> <div class="form-item webform-component webform-component-radios webform-component--product-details-nano--shape"><label for="edit-submitted-product-details-nano-shape">Shape </label> <div id="edit-submitted-product-details-nano-shape" class="form-radios"> <div class="form-item form-type-radio form-item-submitted-product-details-nano-shape"><input type="radio" id="edit-submitted-product-details-nano-shape-1" name="submitted[product_details_nano][shape]" value="1" class="form-radio"> <label class="option" for="edit-submitted-product-details-nano-shape-1">Round </label> </div> <div class="form-item form-type-radio form-item-submitted-product-details-nano-shape"><input type="radio" id="edit-submitted-product-details-nano-shape-2" name="submitted[product_details_nano][shape]" value="2" class="form-radio"> <label class="option" for="edit-submitted-product-details-nano-shape-2">Rectangular </label> </div> </div> </div> <div class="form-item webform-component webform-component-markup webform-component--product-details-nano--dimensions"> <h5>Dimensions</h5> <div class="description"> Please include units of measurement </div> </div> <div class="component-group form-item webform-component webform-component-textfield webform-component--product-details-nano--diameter"><label for="edit-submitted-product-details-nano-diameter">Diameter </label> <input type="text" id="edit-submitted-product-details-nano-diameter" name="submitted[product_details_nano][diameter]" value="" size="60" maxlength="128" class="form-text"> </div> <div class="component-group form-item webform-component webform-component-textfield webform-component--product-details-nano--width"><label for="edit-submitted-product-details-nano-width">Width </label> <input type="text" id="edit-submitted-product-details-nano-width" name="submitted[product_details_nano][width]" value="" size="60" maxlength="128" class="form-text"> </div> <div class="component-group form-item webform-component webform-component-textfield webform-component--product-details-nano--outer-diameter"><label for="edit-submitted-product-details-nano-outer-diameter">Outer Diameter </label> <input type="text" id="edit-submitted-product-details-nano-outer-diameter" name="submitted[product_details_nano][outer_diameter]" value="" size="60" maxlength="128" class="form-text"> </div> <div class="component-group form-item webform-component webform-component-textfield webform-component--product-details-nano--inner-diameter"><label for="edit-submitted-product-details-nano-inner-diameter">Inner Diameter </label> <input type="text" id="edit-submitted-product-details-nano-inner-diameter" name="submitted[product_details_nano][inner_diameter]" value="" size="60" maxlength="128" class="form-text"> </div> <div class="component-group form-item webform-component webform-component-textfield webform-component--product-details-nano--length"><label for="edit-submitted-product-details-nano-length">Length </label> <input type="text" id="edit-submitted-product-details-nano-length" name="submitted[product_details_nano][length]" value="" size="60" maxlength="128" class="form-text"> </div> <div class="component-group form-item webform-component webform-component-textfield webform-component--product-details-nano--thickness"><label for="edit-submitted-product-details-nano-thickness">Thickness </label> <input type="text" id="edit-submitted-product-details-nano-thickness" name="submitted[product_details_nano][thickness]" value="" size="60" maxlength="128" class="form-text"> </div> <div class="backing form-item webform-component webform-component-radios webform-component--product-details-nano--bonded-to-backing-plate"><label for="edit-submitted-product-details-nano-bonded-to-backing-plate">Bonded to Backing Plate? </label> <div id="edit-submitted-product-details-nano-bonded-to-backing-plate" class="form-radios"> <div class="form-item form-type-radio form-item-submitted-product-details-nano-bonded-to-backing-plate"><input type="radio" id="edit-submitted-product-details-nano-bonded-to-backing-plate-1" name="submitted[product_details_nano][bonded_to_backing_plate]" value="1" class="form-radio"> <label class="option" for="edit-submitted-product-details-nano-bonded-to-backing-plate-1">Yes </label> </div> <div class="form-item form-type-radio form-item-submitted-product-details-nano-bonded-to-backing-plate"><input type="radio" id="edit-submitted-product-details-nano-bonded-to-backing-plate-2" name="submitted[product_details_nano][bonded_to_backing_plate]" value="2" class="form-radio"> <label class="option" for="edit-submitted-product-details-nano-bonded-to-backing-plate-2">No </label> </div> </div> </div> <div class="form-item webform-component webform-component-radios webform-component--product-details-nano--customer-provided"><label for="edit-submitted-product-details-nano-customer-provided">Customer Provided? </label> <div id="edit-submitted-product-details-nano-customer-provided" class="form-radios"> <div class="form-item form-type-radio form-item-submitted-product-details-nano-customer-provided"><input type="radio" id="edit-submitted-product-details-nano-customer-provided-1" name="submitted[product_details_nano][customer_provided]" value="1" class="form-radio"> <label class="option" for="edit-submitted-product-details-nano-customer-provided-1">Yes </label> </div> <div class="form-item form-type-radio form-item-submitted-product-details-nano-customer-provided"><input type="radio" id="edit-submitted-product-details-nano-customer-provided-2" name="submitted[product_details_nano][customer_provided]" value="2" class="form-radio"> <label class="option" for="edit-submitted-product-details-nano-customer-provided-2">No </label> </div> </div> </div> <div class="form-item webform-component webform-component-select webform-component--product-details-nano--bond-type"><label for="edit-submitted-product-details-nano-bond-type">Bond Type </label> <select id="edit-submitted-product-details-nano-bond-type" name="submitted[product_details_nano][bond_type]" class="form-select"><option value="" selected>- None -</option><option value="1">Indium</option><option value="2">Elastomer</option><option value="3">Other (Please describe in Additional Information)</option></select> </div> <div class="component-group form-item webform-component webform-component-textfield webform-component--product-details-nano--backing-plate-material"><label for="edit-submitted-product-details-nano-backing-plate-material">Backing Plate Material </label> <input type="text" id="edit-submitted-product-details-nano-backing-plate-material" name="submitted[product_details_nano][backing_plate_material]" value="" size="60" maxlength="128" class="form-text"> </div> <div class="form-item webform-component webform-component-radios webform-component--product-details-nano--backing-plate-same-size-as-target"><label for="edit-submitted-product-details-nano-backing-plate-same-size-as-target">Backing Plate Same Size As Target? </label> <div id="edit-submitted-product-details-nano-backing-plate-same-size-as-target" class="form-radios"> <div class="form-item form-type-radio form-item-submitted-product-details-nano-backing-plate-same-size-as-target"><input type="radio" id="edit-submitted-product-details-nano-backing-plate-same-size-as-target-1" name="submitted[product_details_nano][backing_plate_same_size_as_target]" value="1" class="form-radio"> <label class="option" for="edit-submitted-product-details-nano-backing-plate-same-size-as-target-1">Yes </label> </div> <div class="form-item form-type-radio form-item-submitted-product-details-nano-backing-plate-same-size-as-target"><input type="radio" id="edit-submitted-product-details-nano-backing-plate-same-size-as-target-2" name="submitted[product_details_nano][backing_plate_same_size_as_target]" value="2" class="form-radio"> <label class="option" for="edit-submitted-product-details-nano-backing-plate-same-size-as-target-2">No </label> </div> </div> </div> <div class="backing-size form-item webform-component webform-component-textfield webform-component--product-details-nano--backing-plate-size"><label class="element-invisible" for="edit-submitted-product-details-nano-backing-plate-size">Backing Plate Size </label> <input type="text" id="edit-submitted-product-details-nano-backing-plate-size" name="submitted[product_details_nano][backing_plate_size]" value="" size="60" maxlength="128" class="form-text"> <div class="description"> Please specify backing plate dimensions </div> </div> <div class="form-item webform-component webform-component-select webform-component--product-details-nano--solvent-type"><label for="edit-submitted-product-details-nano-solvent-type">Solvent Type </label> <select id="edit-submitted-product-details-nano-solvent-type" name="submitted[product_details_nano][solvent_type]" class="form-select"><option value="1" selected>Water</option><option value="2">Alcohol (Please specify below)</option><option value="3">Other (Please specify below)</option></select> </div> <div class="form-item webform-component webform-component-select webform-component--product-details-nano--desired-particle-size"><label for="edit-submitted-product-details-nano-desired-particle-size">Desired Particle Size </label> <select id="edit-submitted-product-details-nano-desired-particle-size" name="submitted[product_details_nano][desired_particle_size]" class="form-select"><option value="1" selected>Submicron (< 1 micron)</option><option value="2">< 100nm</option><option value="3">Other (Please describe below)</option></select> </div> <div class="form-item webform-component webform-component-textfield webform-component--product-details-nano--desired-concentration"><label for="edit-submitted-product-details-nano-desired-concentration">Desired Concentration </label> <input type="text" id="edit-submitted-product-details-nano-desired-concentration" name="submitted[product_details_nano][desired_concentration]" value="" size="60" maxlength="128" class="form-text"> </div> <div class="form-item webform-component webform-component-number webform-component--product-details-nano--quantity-number"><label for="edit-submitted-product-details-nano-quantity-number">Quantity </label> <input type="text" id="edit-submitted-product-details-nano-quantity-number" name="submitted[product_details_nano][quantity_number]" size="3" min="1" max="10" step="1" class="form-text form-number"> </div> <div class="form-item webform-component webform-component-textarea webform-component--product-details-nano--quantity-text"><label for="edit-submitted-product-details-nano-quantity-text">Quantity </label> <div class="form-textarea-wrapper resizable"> <textarea placeholder="Please state quantity or volume, and if product will be purchased more than once a year, your annual usage" id="edit-submitted-product-details-nano-quantity-text" name="submitted[product_details_nano][quantity_text]" cols="60" rows="3" class="form-textarea"></textarea> </div> </div> <div class="form-item webform-component webform-component-textarea webform-component--product-details-nano--specifications"><label for="edit-submitted-product-details-nano-specifications">Additional Specifications or Notes </label> <div class="form-textarea-wrapper resizable"> <textarea placeholder="Please include any additional requirements you have for this material" id="edit-submitted-product-details-nano-specifications" name="submitted[product_details_nano][specifications]" cols="60" rows="3" class="form-textarea"></textarea> </div> </div> </div> </fieldset> <fieldset class="webform-component-fieldset collapsible collapsed webform-component--additional-information form-wrapper"> <legend><span class="fieldset-legend">Optional Information</span></legend> <div class="fieldset-wrapper"> <div class="form-item webform-component webform-component-markup webform-component--additional-information--technical-specifications"><label>Technical Specifications</label> <div class="description"> Optional: Upload supplemental files regarding your technical specifications such as images, documents, or CAD files </div> </div> <div id="edit-submitted-additional-information-file-ajax-wrapper"> <div class="tech-specs form-item webform-component webform-component-file webform-component--additional-information--file"><label class="element-invisible" for="edit-submitted-additional-information-file-upload">Technical Specifications </label> <div class="form-managed-file"> <input type="file" id="edit-submitted-additional-information-file-upload" name="files[submitted_additional_information_file]" size="22" class="form-file"><input type="submit" id="edit-submitted-additional-information-file-upload-button" name="submitted_additional_information_file_upload_button" value="Upload" class="form-submit"><input type="hidden" name="submitted[additional_information][file][fid]" value="0"> </div> <div class="description"> Files must be less than <strong>2 MB</strong>.<br> Allowed file types: <strong>gif jpg jpeg png bmp tif txt rtf pdf doc docx xls xlsx zip dxf dwg amf</strong>. </div> </div> </div> <div class="form-item webform-component webform-component-textarea webform-component--additional-information--repeat-order"><label for="edit-submitted-additional-information-repeat-order">Will this same order be repeated in the future? </label> <div class="form-textarea-wrapper resizable"> <textarea placeholder="A term contract will further reduce the cost." id="edit-submitted-additional-information-repeat-order" name="submitted[additional_information][repeat_order]" cols="60" rows="3" class="form-textarea"></textarea> </div> </div> <div class="form-item webform-component webform-component-textarea webform-component--additional-information--intended-use-or-application"><label for="edit-submitted-additional-information-intended-use-or-application">Intended Use or Application </label> <div class="form-textarea-wrapper resizable"> <textarea placeholder="Please describe non-proprietary applications you'd like us to consider to better engineer your material." id="edit-submitted-additional-information-intended-use-or-application" name="submitted[additional_information][intended_use_or_application]" cols="60" rows="3" class="form-textarea"></textarea> </div> </div> <div class="form-item webform-component webform-component-textarea webform-component--additional-information--additional-requests"><label for="edit-submitted-additional-information-additional-requests">Additional Requests </label> <div class="form-textarea-wrapper resizable"> <textarea placeholder="Any other information that would help us to better serve you?" id="edit-submitted-additional-information-additional-requests" name="submitted[additional_information][additional_requests]" cols="60" rows="3" class="form-textarea"></textarea> </div> </div> </div> </fieldset> <div class="form-item webform-component webform-component-checkboxes webform-component--add-another-product"><label class="element-invisible" for="edit-submitted-add-another-product">Add another product </label> <div id="edit-submitted-add-another-product" class="form-checkboxes"> <div class="form-item form-type-checkbox form-item-submitted-add-another-product-add-product2"><input type="checkbox" id="edit-submitted-add-another-product-1" name="submitted[add_another_product][add_product2]" value="add_product2" class="form-checkbox"> <label class="option" for="edit-submitted-add-another-product-1">Add another product </label> </div> </div> </div> <fieldset class="webform-component-fieldset more-products webform-component--product-2 form-wrapper"> <legend><span class="fieldset-legend">Product 2</span></legend> <div class="fieldset-wrapper"> <div class="form-item webform-component webform-component-textfield webform-component--product-2--product-name2"><label for="edit-submitted-product-2-product-name2">Product Name <span class="form-required" title="This field is required.">*</span></label> <input required type="text" id="edit-submitted-product-2-product-name2" name="submitted[product_2][product_name2]" value="" size="60" maxlength="128" class="form-text required"> </div> <div class="form-item webform-component webform-component-textfield webform-component--product-2--product-code"><label for="edit-submitted-product-2-product-code">Product Code </label> <input type="text" id="edit-submitted-product-2-product-code" name="submitted[product_2][product_code]" value="" size="60" maxlength="128" class="form-text"> </div> <div class="form-item webform-component webform-component-textfield webform-component--product-2--cas-number"><label for="edit-submitted-product-2-cas-number">CAS Number </label> <input type="text" id="edit-submitted-product-2-cas-number" name="submitted[product_2][cas_number]" value="" size="60" maxlength="128" class="form-text"> </div> <div class="form-item webform-component webform-component-select webform-component--product-2--purity"><label for="edit-submitted-product-2-purity">Purity </label> <select multiple name="submitted[product_2][purity][]" id="edit-submitted-product-2-purity" size="4" class="form-select"><option value="TG">Technical Grade</option><option value="018">98%</option><option value="02">(2N) 99%</option><option value="03">(3N) 99.9%</option><option value="04">(4N) 99.99%</option><option value="05">(5N) 99.999%</option><option value="06">(6N) 99.9999% (check availability)</option><option value="07">(7N) 99.99999% (check availability)</option><option value="01">Other (please describe below)</option></select> <div class="description"> Select the purity closest to your requirements. </div> </div> <div class="form-item webform-component webform-component-textfield webform-component--product-2--iupac-name-2"><label for="edit-submitted-product-2-iupac-name-2">IUPAC Name </label> <input type="text" id="edit-submitted-product-2-iupac-name-2" name="submitted[product_2][iupac_name_2]" value="" size="60" maxlength="128" class="form-text"> <div class="description"> (optional) </div> </div> </div> </fieldset> <fieldset class="webform-component-fieldset webform-component--additional-information2 form-wrapper"> <legend><span class="fieldset-legend">Details</span></legend> <div class="fieldset-wrapper"> <div class="form-item webform-component webform-component-textarea webform-component--additional-information2--requested-volume-or-quantity"><label for="edit-submitted-additional-information2-requested-volume-or-quantity">Requested Volume or Quantity <span class="form-required" title="This field is required.">*</span></label> <div class="form-textarea-wrapper resizable"> <textarea required placeholder="Please state quantity and if product will be purchased more than once a year, your annual usage" id="edit-submitted-additional-information2-requested-volume-or-quantity" name="submitted[additional_information2][requested_volume_or_quantity]" cols="60" rows="3" class="form-textarea required"></textarea> </div> </div> <div class="form-item webform-component webform-component-textarea webform-component--additional-information2--repeat-order"><label for="edit-submitted-additional-information2-repeat-order">Will this same order be repeated in the future? (Optional) </label> <div class="form-textarea-wrapper resizable"> <textarea placeholder="A term contract will further reduce the cost." id="edit-submitted-additional-information2-repeat-order" name="submitted[additional_information2][repeat_order]" cols="60" rows="3" class="form-textarea"></textarea> </div> </div> <div class="form-item webform-component webform-component-textarea webform-component--additional-information2--specifications"><label for="edit-submitted-additional-information2-specifications">Specifications (Optional) </label> <div class="form-textarea-wrapper resizable"> <textarea placeholder="Please indicate any custom specifications for this material such as particle size, critical impurities or packaging specs." id="edit-submitted-additional-information2-specifications" name="submitted[additional_information2][specifications]" cols="60" rows="3" class="form-textarea"></textarea> </div> </div> <div class="form-item webform-component webform-component-textarea webform-component--additional-information2--intended-use-or-application"><label for="edit-submitted-additional-information2-intended-use-or-application">Intended Use or Application (Optional) </label> <div class="form-textarea-wrapper resizable"> <textarea placeholder="Please describe non-proprietary applications you'd like us to consider to better engineer your material." id="edit-submitted-additional-information2-intended-use-or-application" name="submitted[additional_information2][intended_use_or_application]" cols="60" rows="3" class="form-textarea"></textarea> </div> </div> <div class="form-item webform-component webform-component-textarea webform-component--additional-information2--additional-requests"><label for="edit-submitted-additional-information2-additional-requests">Additional Requests (Optional) </label> <div class="form-textarea-wrapper resizable"> <textarea placeholder="Any other information that would help us to better serve you?" id="edit-submitted-additional-information2-additional-requests" name="submitted[additional_information2][additional_requests]" cols="60" rows="3" class="form-textarea"></textarea> </div> </div> <div class="form-item webform-component webform-component-checkboxes webform-component--additional-information2--add-another-product2"><label class="element-invisible" for="edit-submitted-additional-information2-add-another-product2">Add another product </label> <div id="edit-submitted-additional-information2-add-another-product2" class="form-checkboxes"> <div class="form-item form-type-checkbox form-item-submitted-additional-information2-add-another-product2-add-product2"><input type="checkbox" id="edit-submitted-additional-information2-add-another-product2-1" name="submitted[additional_information2][add_another_product2][add_product2]" value="add_product2" class="form-checkbox"> <label class="option" for="edit-submitted-additional-information2-add-another-product2-1">Add another product </label> </div> </div> </div> </div> </fieldset> <fieldset class="webform-component-fieldset more-products webform-component--product-3 form-wrapper"> <legend><span class="fieldset-legend">Product 3</span></legend> <div class="fieldset-wrapper"> <div class="form-item webform-component webform-component-textfield webform-component--product-3--product-name"><label for="edit-submitted-product-3-product-name">Product Name <span class="form-required" title="This field is required.">*</span></label> <input required type="text" id="edit-submitted-product-3-product-name" name="submitted[product_3][product_name]" value="" size="60" maxlength="128" class="form-text required"> </div> <div class="form-item webform-component webform-component-textfield webform-component--product-3--product-code"><label for="edit-submitted-product-3-product-code">Product Code </label> <input type="text" id="edit-submitted-product-3-product-code" name="submitted[product_3][product_code]" value="" size="60" maxlength="128" class="form-text"> </div> <div class="form-item webform-component webform-component-textfield webform-component--product-3--cas-number3"><label for="edit-submitted-product-3-cas-number3">CAS Number </label> <input type="text" id="edit-submitted-product-3-cas-number3" name="submitted[product_3][cas_number3]" value="" size="60" maxlength="128" class="form-text"> </div> <div class="form-item webform-component webform-component-select webform-component--product-3--purity"><label for="edit-submitted-product-3-purity">Purity </label> <select multiple name="submitted[product_3][purity][]" id="edit-submitted-product-3-purity" size="4" class="form-select"><option value="TG">Technical Grade</option><option value="018">98%</option><option value="02">(2N) 99%</option><option value="03">(3N) 99.9%</option><option value="04">(4N) 99.99%</option><option value="05">(5N) 99.999%</option><option value="06">(6N) 99.9999% (check availability)</option><option value="07">(7N) 99.99999% (check availability)</option><option value="01">Other (please describe below)</option></select> <div class="description"> Select the purity closest to your requirements. </div> </div> </div> </fieldset> <fieldset class="webform-component-fieldset webform-component--additional-information3 form-wrapper"> <legend><span class="fieldset-legend">Details</span></legend> <div class="fieldset-wrapper"> <div class="form-item webform-component webform-component-textarea webform-component--additional-information3--requested-volume-or-quantity"><label for="edit-submitted-additional-information3-requested-volume-or-quantity">Requested Volume or Quantity <span class="form-required" title="This field is required.">*</span></label> <div class="form-textarea-wrapper resizable"> <textarea required placeholder="Please state quantity and if product will be purchased more than once a year, your annual usage" id="edit-submitted-additional-information3-requested-volume-or-quantity" name="submitted[additional_information3][requested_volume_or_quantity]" cols="60" rows="3" class="form-textarea required"></textarea> </div> </div> <div class="form-item webform-component webform-component-textarea webform-component--additional-information3--repeat-order"><label for="edit-submitted-additional-information3-repeat-order">Will this same order be repeated in the future? (Optional) </label> <div class="form-textarea-wrapper resizable"> <textarea placeholder="A term contract will further reduce the cost." id="edit-submitted-additional-information3-repeat-order" name="submitted[additional_information3][repeat_order]" cols="60" rows="3" class="form-textarea"></textarea> </div> </div> <div class="form-item webform-component webform-component-textarea webform-component--additional-information3--specifications"><label for="edit-submitted-additional-information3-specifications">Specifications (Optional) </label> <div class="form-textarea-wrapper resizable"> <textarea placeholder="Please indicate any custom specifications for this material such as particle size, critical impurities or packaging specs." id="edit-submitted-additional-information3-specifications" name="submitted[additional_information3][specifications]" cols="60" rows="3" class="form-textarea"></textarea> </div> </div> <div class="form-item webform-component webform-component-textarea webform-component--additional-information3--intended-use-or-application"><label for="edit-submitted-additional-information3-intended-use-or-application">Intended Use or Application (Optional) </label> <div class="form-textarea-wrapper resizable"> <textarea placeholder="Please describe non-proprietary applications you'd like us to consider to better engineer your material." id="edit-submitted-additional-information3-intended-use-or-application" name="submitted[additional_information3][intended_use_or_application]" cols="60" rows="3" class="form-textarea"></textarea> </div> </div> <div class="form-item webform-component webform-component-textarea webform-component--additional-information3--additional-requests"><label for="edit-submitted-additional-information3-additional-requests">Additional Requests (Optional) </label> <div class="form-textarea-wrapper resizable"> <textarea placeholder="Any other information that would help us to better serve you?" id="edit-submitted-additional-information3-additional-requests" name="submitted[additional_information3][additional_requests]" cols="60" rows="3" class="form-textarea"></textarea> </div> </div> <div class="form-item webform-component webform-component-checkboxes webform-component--additional-information3--add-another-product4"><label class="element-invisible" for="edit-submitted-additional-information3-add-another-product4">Add another product </label> <div id="edit-submitted-additional-information3-add-another-product4" class="form-checkboxes"> <div class="form-item form-type-checkbox form-item-submitted-additional-information3-add-another-product4-add-product2"><input type="checkbox" id="edit-submitted-additional-information3-add-another-product4-1" name="submitted[additional_information3][add_another_product4][add_product2]" value="add_product2" class="form-checkbox"> <label class="option" for="edit-submitted-additional-information3-add-another-product4-1">Add another product </label> </div> </div> </div> </div> </fieldset> <fieldset class="webform-component-fieldset more-products webform-component--product-4 form-wrapper"> <legend><span class="fieldset-legend">Product 4</span></legend> <div class="fieldset-wrapper"> <div class="form-item webform-component webform-component-textfield webform-component--product-4--product-name"><label for="edit-submitted-product-4-product-name">Product Name <span class="form-required" title="This field is required.">*</span></label> <input required type="text" id="edit-submitted-product-4-product-name" name="submitted[product_4][product_name]" value="" size="60" maxlength="128" class="form-text required"> </div> <div class="form-item webform-component webform-component-textfield webform-component--product-4--product-code"><label for="edit-submitted-product-4-product-code">Product Code </label> <input type="text" id="edit-submitted-product-4-product-code" name="submitted[product_4][product_code]" value="" size="60" maxlength="128" class="form-text"> </div> <div class="form-item webform-component webform-component-textfield webform-component--product-4--cas-number"><label for="edit-submitted-product-4-cas-number">CAS Number </label> <input type="text" id="edit-submitted-product-4-cas-number" name="submitted[product_4][cas_number]" value="" size="60" maxlength="128" class="form-text"> </div> <div class="form-item webform-component webform-component-select webform-component--product-4--purity"><label for="edit-submitted-product-4-purity">Purity </label> <select id="edit-submitted-product-4-purity" name="submitted[product_4][purity]" class="form-select"><option value="" selected>- None -</option><option value="TG">Technical Grade</option><option value="018">98%</option><option value="02">(2N) 99%</option><option value="03">(3N) 99.9%</option><option value="04">(4N) 99.99%</option><option value="05">(5N) 99.999%</option><option value="06">(6N) 99.9999% (check availability)</option><option value="07">(7N) 99.99999% (check availability)</option><option value="01">Other (please describe below)</option></select> <div class="description"> Select the purity closest to your requirements. </div> </div> </div> </fieldset> <fieldset class="webform-component-fieldset webform-component--additional-information4 form-wrapper"> <legend><span class="fieldset-legend">Details</span></legend> <div class="fieldset-wrapper"> <div class="form-item webform-component webform-component-textarea webform-component--additional-information4--requested-volume-or-quantity"><label for="edit-submitted-additional-information4-requested-volume-or-quantity">Requested Volume or Quantity <span class="form-required" title="This field is required.">*</span></label> <div class="form-textarea-wrapper resizable"> <textarea required placeholder="Please state quantity and if product will be purchased more than once a year, your annual usage" id="edit-submitted-additional-information4-requested-volume-or-quantity" name="submitted[additional_information4][requested_volume_or_quantity]" cols="60" rows="3" class="form-textarea required"></textarea> </div> </div> <div class="form-item webform-component webform-component-textarea webform-component--additional-information4--repeat-order"><label for="edit-submitted-additional-information4-repeat-order">Will this same order be repeated in the future? (Optional) </label> <div class="form-textarea-wrapper resizable"> <textarea placeholder="A term contract will further reduce the cost." id="edit-submitted-additional-information4-repeat-order" name="submitted[additional_information4][repeat_order]" cols="60" rows="3" class="form-textarea"></textarea> </div> </div> <div class="form-item webform-component webform-component-textarea webform-component--additional-information4--specifications"><label for="edit-submitted-additional-information4-specifications">Specifications (Optional) </label> <div class="form-textarea-wrapper resizable"> <textarea placeholder="Please indicate any custom specifications for this material such as particle size, critical impurities or packaging specs." id="edit-submitted-additional-information4-specifications" name="submitted[additional_information4][specifications]" cols="60" rows="3" class="form-textarea"></textarea> </div> </div> <div class="form-item webform-component webform-component-textarea webform-component--additional-information4--intended-use-or-application"><label for="edit-submitted-additional-information4-intended-use-or-application">Intended Use or Application (Optional) </label> <div class="form-textarea-wrapper resizable"> <textarea placeholder="Please describe non-proprietary applications you'd like us to consider to better engineer your material." id="edit-submitted-additional-information4-intended-use-or-application" name="submitted[additional_information4][intended_use_or_application]" cols="60" rows="3" class="form-textarea"></textarea> </div> </div> <div class="form-item webform-component webform-component-textarea webform-component--additional-information4--additional-requests"><label for="edit-submitted-additional-information4-additional-requests">Additional Requests (Optional) </label> <div class="form-textarea-wrapper resizable"> <textarea placeholder="Any other information that would help us to better serve you?" id="edit-submitted-additional-information4-additional-requests" name="submitted[additional_information4][additional_requests]" cols="60" rows="3" class="form-textarea"></textarea> </div> </div> <div class="form-item webform-component webform-component-checkboxes webform-component--additional-information4--add-another-product5"><label class="element-invisible" for="edit-submitted-additional-information4-add-another-product5">Add another product </label> <div id="edit-submitted-additional-information4-add-another-product5" class="form-checkboxes"> <div class="form-item form-type-checkbox form-item-submitted-additional-information4-add-another-product5-add-product2"><input type="checkbox" id="edit-submitted-additional-information4-add-another-product5-1" name="submitted[additional_information4][add_another_product5][add_product2]" value="add_product2" class="form-checkbox"> <label class="option" for="edit-submitted-additional-information4-add-another-product5-1">Add another product </label> </div> </div> </div> <div class="form-item webform-component webform-component-textarea webform-component--additional-information4--additional-products2"><label for="edit-submitted-additional-information4-additional-products2">Additional Products </label> <div class="form-textarea-wrapper resizable"> <textarea id="edit-submitted-additional-information4-additional-products2" name="submitted[additional_information4][additional_products2]" cols="60" rows="4" class="form-textarea">Please describe any additional products you would like to request pricing for.</textarea> </div> </div> </div> </fieldset> <fieldset class="webform-component-fieldset webform-component--customer-information form-wrapper"> <legend><span class="fieldset-legend">Customer Information</span></legend> <div class="fieldset-wrapper"> <div class="inline-float form-item webform-component webform-component-textfield webform-component--customer-information--first-name"><label for="edit-submitted-customer-information-first-name">First Name <span class="form-required" title="This field is required.">*</span></label> <input required type="text" id="edit-submitted-customer-information-first-name" name="submitted[customer_information][first_name]" value="" size="30" maxlength="128" class="form-text required"> </div> <div class="inline-float form-item webform-component webform-component-textfield webform-component--customer-information--last-name"><label for="edit-submitted-customer-information-last-name">Last Name <span class="form-required" title="This field is required.">*</span></label> <input required type="text" id="edit-submitted-customer-information-last-name" name="submitted[customer_information][last_name]" value="" size="30" maxlength="128" class="form-text required"> </div> <div class="form-item webform-component webform-component-email webform-component--customer-information--email-address"><label for="edit-submitted-customer-information-email-address">Email Address <span class="form-required" title="This field is required.">*</span></label> <input required class="email form-text form-email required" type="email" id="edit-submitted-customer-information-email-address" name="submitted[customer_information][email_address]" size="60"> </div> <div class="form-item webform-component webform-component-textfield webform-component--customer-information--telephone"><label for="edit-submitted-customer-information-telephone">Telephone <span class="form-required" title="This field is required.">*</span></label> <input required type="text" id="edit-submitted-customer-information-telephone" name="submitted[customer_information][telephone]" value="" size="60" maxlength="128" class="form-text required"> <div class="description"> For U.S. and Canada, please enter in the format 123-456-7890 (using dashes). For all others, please include country code. </div> </div> <div class="form-item webform-component webform-component-textfield webform-component--customer-information--company-or-organization"><label for="edit-submitted-customer-information-company-or-organization">Company or Organization (or enter N/A if no affiliation) <span class="form-required" title="This field is required.">*</span></label> <input required type="text" id="edit-submitted-customer-information-company-or-organization" name="submitted[customer_information][company_or_organization]" value="" size="60" maxlength="128" class="form-text required"> </div> <div class="form-item webform-component webform-component-textfield webform-component--customer-information--country"><label for="edit-submitted-customer-information-country">Country <span class="form-required" title="This field is required.">*</span></label> <input required type="text" id="edit-submitted-customer-information-country" name="submitted[customer_information][country]" value="" size="60" maxlength="128" class="form-text required"> </div> <fieldset class="webform-component-fieldset collapsible collapsed webform-component--customer-information--address-optional form-wrapper"> <legend><span class="fieldset-legend">Address (Optional)</span></legend> <div class="fieldset-wrapper"> <div id="addressfield-wrapper"> <div class="addressfieldwrap form-item webform-component webform-component-addressfield webform-component--customer-information--address-optional--billing-address"><label class="element-invisible">Address </label> <div class="form-item form-type-select form-item-submitted-customer-information-address-optional-billing-address-country"><label for="edit-submitted-customer-information-address-optional-billing-address-country">Country </label> <select class="country form-select" autocomplete="country" id="edit-submitted-customer-information-address-optional-billing-address-country" name="submitted[customer_information][address_optional][billing_address][country]"><option value="">- None -</option><option value="AF">Afghanistan</option><option value="AX">Aland Islands</option><option value="AL">Albania</option><option value="DZ">Algeria</option><option value="AS">American Samoa</option><option value="AD">Andorra</option><option value="AO">Angola</option><option value="AI">Anguilla</option><option value="AQ">Antarctica</option><option value="AG">Antigua and Barbuda</option><option value="AR">Argentina</option><option value="AM">Armenia</option><option value="AW">Aruba</option><option value="AU">Australia</option><option value="AT">Austria</option><option value="AZ">Azerbaijan</option><option value="BS">Bahamas</option><option value="BH">Bahrain</option><option value="BD">Bangladesh</option><option value="BB">Barbados</option><option value="BY">Belarus</option><option value="BE">Belgium</option><option value="BZ">Belize</option><option value="BJ">Benin</option><option value="BM">Bermuda</option><option value="BT">Bhutan</option><option value="BO">Bolivia</option><option value="BA">Bosnia and Herzegovina</option><option value="BW">Botswana</option><option value="BV">Bouvet Island</option><option value="BR">Brazil</option><option value="IO">British Indian Ocean Territory</option><option value="VG">British Virgin Islands</option><option value="BN">Brunei</option><option value="BG">Bulgaria</option><option value="BF">Burkina Faso</option><option value="BI">Burundi</option><option value="KH">Cambodia</option><option value="CM">Cameroon</option><option value="CA">Canada</option><option value="CV">Cape Verde</option><option value="BQ">Caribbean Netherlands</option><option value="KY">Cayman Islands</option><option value="CF">Central African Republic</option><option value="TD">Chad</option><option value="CL">Chile</option><option value="CN">China</option><option value="CX">Christmas Island</option><option value="CC">Cocos (Keeling) Islands</option><option value="CO">Colombia</option><option value="KM">Comoros</option><option value="CG">Congo (Brazzaville)</option><option value="CD">Congo (Kinshasa)</option><option value="CK">Cook Islands</option><option value="CR">Costa Rica</option><option value="HR">Croatia</option><option value="CU">Cuba</option><option value="CW">Curaçao</option><option value="CY">Cyprus</option><option value="CZ">Czech Republic</option><option value="DK">Denmark</option><option value="DJ">Djibouti</option><option value="DM">Dominica</option><option value="DO">Dominican Republic</option><option value="EC">Ecuador</option><option value="EG">Egypt</option><option value="SV">El Salvador</option><option value="GQ">Equatorial Guinea</option><option value="ER">Eritrea</option><option value="EE">Estonia</option><option value="ET">Ethiopia</option><option value="FK">Falkland Islands</option><option value="FO">Faroe Islands</option><option value="FJ">Fiji</option><option value="FI">Finland</option><option value="FR">France</option><option value="GF">French Guiana</option><option value="PF">French Polynesia</option><option value="TF">French Southern Territories</option><option value="GA">Gabon</option><option value="GM">Gambia</option><option value="GE">Georgia</option><option value="DE">Germany</option><option value="GH">Ghana</option><option value="GI">Gibraltar</option><option value="GR">Greece</option><option value="GL">Greenland</option><option value="GD">Grenada</option><option value="GP">Guadeloupe</option><option value="GU">Guam</option><option value="GT">Guatemala</option><option value="GG">Guernsey</option><option value="GN">Guinea</option><option value="GW">Guinea-Bissau</option><option value="GY">Guyana</option><option value="HT">Haiti</option><option value="HM">Heard Island and McDonald Islands</option><option value="HN">Honduras</option><option value="HK">Hong Kong S.A.R., China</option><option value="HU">Hungary</option><option value="IS">Iceland</option><option value="IN">India</option><option value="ID">Indonesia</option><option value="IR">Iran</option><option value="IQ">Iraq</option><option value="IE">Ireland</option><option value="IM">Isle of Man</option><option value="IL">Israel</option><option value="IT">Italy</option><option value="CI">Ivory Coast</option><option value="JM">Jamaica</option><option value="JP">Japan</option><option value="JE">Jersey</option><option value="JO">Jordan</option><option value="KZ">Kazakhstan</option><option value="KE">Kenya</option><option value="KI">Kiribati</option><option value="KW">Kuwait</option><option value="KG">Kyrgyzstan</option><option value="LA">Laos</option><option value="LV">Latvia</option><option value="LB">Lebanon</option><option value="LS">Lesotho</option><option value="LR">Liberia</option><option value="LY">Libya</option><option value="LI">Liechtenstein</option><option value="LT">Lithuania</option><option value="LU">Luxembourg</option><option value="MO">Macao S.A.R., China</option><option value="MK">Macedonia</option><option value="MG">Madagascar</option><option value="MW">Malawi</option><option value="MY">Malaysia</option><option value="MV">Maldives</option><option value="ML">Mali</option><option value="MT">Malta</option><option value="MH">Marshall Islands</option><option value="MQ">Martinique</option><option value="MR">Mauritania</option><option value="MU">Mauritius</option><option value="YT">Mayotte</option><option value="MX">Mexico</option><option value="FM">Micronesia</option><option value="MD">Moldova</option><option value="MC">Monaco</option><option value="MN">Mongolia</option><option value="ME">Montenegro</option><option value="MS">Montserrat</option><option value="MA">Morocco</option><option value="MZ">Mozambique</option><option value="MM">Myanmar</option><option value="NA">Namibia</option><option value="NR">Nauru</option><option value="NP">Nepal</option><option value="NL">Netherlands</option><option value="AN">Netherlands Antilles</option><option value="NC">New Caledonia</option><option value="NZ">New Zealand</option><option value="NI">Nicaragua</option><option value="NE">Niger</option><option value="NG">Nigeria</option><option value="NU">Niue</option><option value="NF">Norfolk Island</option><option value="MP">Northern Mariana Islands</option><option value="KP">North Korea</option><option value="NO">Norway</option><option value="OM">Oman</option><option value="PK">Pakistan</option><option value="PW">Palau</option><option value="PS">Palestinian Territory</option><option value="PA">Panama</option><option value="PG">Papua New Guinea</option><option value="PY">Paraguay</option><option value="PE">Peru</option><option value="PH">Philippines</option><option value="PN">Pitcairn</option><option value="PL">Poland</option><option value="PT">Portugal</option><option value="PR">Puerto Rico</option><option value="QA">Qatar</option><option value="RE">Reunion</option><option value="RO">Romania</option><option value="RU">Russia</option><option value="RW">Rwanda</option><option value="BL">Saint Barthélemy</option><option value="SH">Saint Helena</option><option value="KN">Saint Kitts and Nevis</option><option value="LC">Saint Lucia</option><option value="MF">Saint Martin (French part)</option><option value="PM">Saint Pierre and Miquelon</option><option value="VC">Saint Vincent and the Grenadines</option><option value="WS">Samoa</option><option value="SM">San Marino</option><option value="ST">Sao Tome and Principe</option><option value="SA">Saudi Arabia</option><option value="SN">Senegal</option><option value="RS">Serbia</option><option value="SC">Seychelles</option><option value="SL">Sierra Leone</option><option value="SG">Singapore</option><option value="SX">Sint Maarten</option><option value="SK">Slovakia</option><option value="SI">Slovenia</option><option value="SB">Solomon Islands</option><option value="SO">Somalia</option><option value="ZA">South Africa</option><option value="GS">South Georgia and the South Sandwich Islands</option><option value="KR">South Korea</option><option value="SS">South Sudan</option><option value="ES">Spain</option><option value="LK">Sri Lanka</option><option value="SD">Sudan</option><option value="SR">Suriname</option><option value="SJ">Svalbard and Jan Mayen</option><option value="SZ">Swaziland</option><option value="SE">Sweden</option><option value="CH">Switzerland</option><option value="SY">Syria</option><option value="TW">Taiwan</option><option value="TJ">Tajikistan</option><option value="TZ">Tanzania</option><option value="TH">Thailand</option><option value="TL">Timor-Leste</option><option value="TG">Togo</option><option value="TK">Tokelau</option><option value="TO">Tonga</option><option value="TT">Trinidad and Tobago</option><option value="TN">Tunisia</option><option value="TR">Turkey</option><option value="TM">Turkmenistan</option><option value="TC">Turks and Caicos Islands</option><option value="TV">Tuvalu</option><option value="VI">U.S. Virgin Islands</option><option value="UG">Uganda</option><option value="UA">Ukraine</option><option value="AE">United Arab Emirates</option><option value="GB">United Kingdom</option><option value="US" selected>United States</option><option value="UM">United States Minor Outlying Islands</option><option value="UY">Uruguay</option><option value="UZ">Uzbekistan</option><option value="VU">Vanuatu</option><option value="VA">Vatican</option><option value="VE">Venezuela</option><option value="VN">Vietnam</option><option value="WF">Wallis and Futuna</option><option value="EH">Western Sahara</option><option value="YE">Yemen</option><option value="ZM">Zambia</option><option value="ZW">Zimbabwe</option></select> </div> <div class="street-block"> <div class="form-item form-type-textfield form-item-submitted-customer-information-address-optional-billing-address-thoroughfare"><label for="edit-submitted-customer-information-address-optional-billing-address-thoroughfare">Address 1 </label> <input class="thoroughfare form-text" autocomplete="address-line1" type="text" id="edit-submitted-customer-information-address-optional-billing-address-thoroughfare" name="submitted[customer_information][address_optional][billing_address][thoroughfare]" value="" size="30" maxlength="255"> </div> <div class="form-item form-type-textfield form-item-submitted-customer-information-address-optional-billing-address-premise"><label for="edit-submitted-customer-information-address-optional-billing-address-premise">Address 2 </label> <input class="premise form-text" autocomplete="address-line2" type="text" id="edit-submitted-customer-information-address-optional-billing-address-premise" name="submitted[customer_information][address_optional][billing_address][premise]" value="" size="30" maxlength="255"> </div> </div> <div class="addressfield-container-inline locality-block country-US"> <div class="form-item form-type-textfield form-item-submitted-customer-information-address-optional-billing-address-locality"><label for="edit-submitted-customer-information-address-optional-billing-address-locality">City </label> <input class="locality form-text" autocomplete="address-level2" type="text" id="edit-submitted-customer-information-address-optional-billing-address-locality" name="submitted[customer_information][address_optional][billing_address][locality]" value="" size="30" maxlength="255"> </div> <div class="form-item form-type-select form-item-submitted-customer-information-address-optional-billing-address-administrative-area"><label for="edit-submitted-customer-information-address-optional-billing-address-administrative-area">State </label> <select class="state form-select" autocomplete="address-level1" id="edit-submitted-customer-information-address-optional-billing-address-administrative-area" name="submitted[customer_information][address_optional][billing_address][administrative_area]"><option value="" selected>- None -</option><option value="AL">Alabama</option><option value="AK">Alaska</option><option value="AZ">Arizona</option><option value="AR">Arkansas</option><option value="CA">California</option><option value="CO">Colorado</option><option value="CT">Connecticut</option><option value="DE">Delaware</option><option value="DC">District of Columbia</option><option value="FL">Florida</option><option value="GA">Georgia</option><option value="HI">Hawaii</option><option value="ID">Idaho</option><option value="IL">Illinois</option><option value="IN">Indiana</option><option value="IA">Iowa</option><option value="KS">Kansas</option><option value="KY">Kentucky</option><option value="LA">Louisiana</option><option value="ME">Maine</option><option value="MD">Maryland</option><option value="MA">Massachusetts</option><option value="MI">Michigan</option><option value="MN">Minnesota</option><option value="MS">Mississippi</option><option value="MO">Missouri</option><option value="MT">Montana</option><option value="NE">Nebraska</option><option value="NV">Nevada</option><option value="NH">New Hampshire</option><option value="NJ">New Jersey</option><option value="NM">New Mexico</option><option value="NY">New York</option><option value="NC">North Carolina</option><option value="ND">North Dakota</option><option value="OH">Ohio</option><option value="OK">Oklahoma</option><option value="OR">Oregon</option><option value="PA">Pennsylvania</option><option value="RI">Rhode Island</option><option value="SC">South Carolina</option><option value="SD">South Dakota</option><option value="TN">Tennessee</option><option value="TX">Texas</option><option value="UT">Utah</option><option value="VT">Vermont</option><option value="VA">Virginia</option><option value="WA">Washington</option><option value="WV">West Virginia</option><option value="WI">Wisconsin</option><option value="WY">Wyoming</option><option value=" ">--</option><option value="AA">Armed Forces (Americas)</option><option value="AE">Armed Forces (Europe, Canada, Middle East, Africa)</option><option value="AP">Armed Forces (Pacific)</option><option value="AS">American Samoa</option><option value="FM">Federated States of Micronesia</option><option value="GU">Guam</option><option value="MH">Marshall Islands</option><option value="MP">Northern Mariana Islands</option><option value="PW">Palau</option><option value="PR">Puerto Rico</option><option value="VI">Virgin Islands</option></select> </div> <div class="form-item form-type-textfield form-item-submitted-customer-information-address-optional-billing-address-postal-code"><label for="edit-submitted-customer-information-address-optional-billing-address-postal-code">ZIP code </label> <input class="postal-code form-text" autocomplete="postal-code" type="text" id="edit-submitted-customer-information-address-optional-billing-address-postal-code" name="submitted[customer_information][address_optional][billing_address][postal_code]" value="" size="10" maxlength="255"> </div> </div> </div> </div> </div> </fieldset> </div> </fieldset> <fieldset class="webform-component-fieldset webform-component--promo-code-label form-wrapper"> <legend><span class="fieldset-legend">Promo Code</span></legend> <div class="fieldset-wrapper"> <div class="form-item webform-component webform-component-textfield webform-component--promo-code-label--promo-code"><label class="element-invisible" for="edit-submitted-promo-code-label-promo-code">Promo Code </label> <input type="text" id="edit-submitted-promo-code-label-promo-code" name="submitted[promo_code_label][promo_code]" value="" size="60" maxlength="128" class="form-text"> </div> </div> </fieldset> <fieldset class="webform-component-fieldset collapsible collapsible collapsed webform-component--terms-content form-wrapper"> <legend><span class="fieldset-legend">Terms & Conditions</span></legend> <div class="fieldset-wrapper"> <div class="form-item webform-component webform-component-markup webform-component--terms-content--terms-content-body"> <p>All orders are accepted and shipped strictly subject to these general terms and conditions, no additional or different terms or conditions stated by buyer shall be applicable, unless agreed to in writing by an authorized representative of American Elements div. of Merelex Corporation ("MC").</p> <h5>Pricing And Order Quantities</h5> <p>Prices are subject to change without notice. Listed prices do not include taxes. All prices listed are FOB MC. A shipping and handling fee may be added to each shipment. Quotations are effective for fourteen (14) days from the date of quotation. MC reserves the right to change prices at time of order due to changing material market conditions. MC reserves the right to ship excess or deficiency (+/- 5%) on materials ordered.</p> <h5>Order Confirmation</h5> <p>All quotations are subject to written confirmation of customers purchase order. No contract is created and MC has no obligations hereunder until such written confirmation is issued by MC.</p> <h5>Shipment Method and Terms</h5> <p>MC reserves the right to alter shipping instructions for hazardous materials covered by the United States Department of Transportation. In the absence of shipping instruction, materials will be shipped by whatever method MC deems appropriate. MC shall not be liable for any delay in, or failure of, its performance of any of its obligations under this Agreement if such delay or failure is caused by events beyond its reasonable control, including but not limited to any acts of God, governmental embargoes, military action, civil disorder, acts of terrorism, fires, floods, vandalism, or the acts of third party suppliers, transporters and/or energy providers. In no event shall MC be liable for consequential or other damages for any delay. The material is at the risk of buyer after delivery to carrier. All risk for shortage, loss, delay or damage in transit should be borne by buyer.</p> <h5>Payment and Impairment of Credit</h5> <p>Payment due dates are specified in MC's quotation and invoice. The net days is counted from the date of invoice, the buyer may be charged interest for over due payments at the rate of 18% per annum on any outstanding balance. The buyer shall reimburse MC, upon demand, for any costs of collection incurred by MC, including reasonable attorneys' fee. If buyer is or becomes insolvent, or is unable to pay its debts as they mature, or files or has files against it a bankruptcy, insolvency, or if MC in good faith doubts the ability of buyer to pay, MC may demand cash payment in advance before shipments are made.</p> <h5>Taxes</h5> <p>Any manufacturer's, retailer's, occupation, use, sales, or excise tax, duty, custom, inspection, or testing fee or any other tax, fee, or charge of any nature imposed by any government authority on or measured by any transaction between MC and the buyer shall be paid by the buyer in addition to the contract price as quoted or invoiced, unless MC specifically states that such taxes or charges are included in the contract price or unless at the time the order is submitted the buyer provides MC an acceptable certificate exempting MC from any such tax, fee or charge, the buyer shall reimburse MC therefore upon demand.</p> <h5>Material Safety Data Sheet</h5> <p>Only the first shipment of a material by MC will be accompanied by a materials safety data sheet (SDS). The SDS is provided in compliance with OSHA. This SDS is prepared by MC's technical staff based upon the best of their knowledge and is offered solely for buyer's information, consideration, and investigation. MC provides no warranties, either express or implied, and assumes no responsibility for the accuracy or completeness of the data contained therein. It is the obligation of the customer to notify MC if it misplaces the product(s) SDS.</p> <h5>Limited Warranty</h5> <p>MC warrants to the buyer, for a period of seven (7) days after the materials are received by buyer, that its products meet the specifications expressly defined in writing as defined in its catalog, certificates of analyses, or written proposals prepared by and authorized by MC's representative. MC does not guarantee any end-use results for any of its products. All claims for errors, defects, or damaged materials against MC must be made by the buyer in writing within seven (7) days of buyer's receipt of the materials in question. Any claims not satisfying this condition shall be deemed waived. The obligations of MC under this warranty shall be limited to replacing such claimed materials or allowing credit at MC’s option, provided the buyer gives MC prompt notice of the defects during the warranty period, and, if required by MC, returns the materials to MC. No claim will be allowed by MC for any materials claimed by the buyer to be defective or unsuitable unless MC is permitted to examine the product(s) before use or processing by the buyer. All errors, defects, or damaged materials claimed by buyer must be confirmed by MC's inspection. Buyer's exclusive remedy, for any cause or claim whatsoever, including but not limited to alleged breach of warranty, product liability, negligence, or otherwise, shall be for money damages in an amount not to exceed the purchase price paid by the buyer for the product(s) in respect to which the claim is made. In no event shall MC be liable for special, incidental or consequential damages, whether buyer's claim in contract, negligence, strict liability or otherwise. In consideration of the sale of the product(s) to the buyer, which sales MC would not otherwise make, buyer agrees to indemnify and hold MC harmless from all claims, expenses, losses and liability of any nature whatsoever arising out of the buyer's handling and/or use of the product(s). In the event of any action to enforce the terms of this contract, the prevailing party shall be entitled to reimbursement of its attorneys’ fees and reasonable court costs. Venue for any action related to this sale shall be Los Angeles, California.</p> </div> </div> </fieldset><input type="hidden" name="details[sid]"><input type="hidden" name="details[page_num]" value="1"><input type="hidden" name="details[page_count]" value="1"><input type="hidden" name="details[finished]" value="0"><input type="hidden" name="form_build_id" value="form-RuE0_IMMRgGYloxiJLtIkpFkbXhm8MZ64SvH8QHFdu4"><input type="hidden" name="form_id" value="webform_client_form_57"><input type="hidden" name="honeypot_time" value="1732779457|0hI4JmCpV94SwrRqmGhGUBC5lpLim3jaBgzVkPZlQms"> <div class="url-textfield"> <div class="form-item form-type-textfield form-item-url"><label for="edit-url">Leave this field blank </label> <input autocomplete="off" type="text" id="edit-url" name="url" value="" size="20" maxlength="128" class="form-text"> </div> </div> <div class="form-actions"> <input class="webform-submit button-primary form-submit" type="submit" name="op" value="Submit"> </div> </div> </form> </div> </div> <div class="panel-separator"></div> <div class="panel-pane pane-entity-field pane-node-field-form-page-content"> <div class="pane-content"> <div class="field-form-page-content"><br><br><br> <hr> <div id="contactinfo"> <h3>Company Contact Information</h3> <div class="panel-info"> <div class="panel-heading"> New Customer Sales & Technical Service </div> <div class="panel-body"> <div class="contact-office"> <h4><a href="https://translate.google.com/website?sl=en&tl=nl&hl=en&u=http://www.americanelements.com/company.html">US Corporate Headquarters</a></h4> <div itemscope itemtype="http://schema.org/Organization"> <span itemprop="name">American Elements</span> <div itemprop="address" itemscope itemtype="http://schema.org/PostalAddress"> <span itemprop="streetAddress">10884 Weyburn Avenue</span><span itemprop="addressLocality">Los Angeles, CA</span><span itemprop="postalCode">90024</span><span>USA</span><a 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