University Research Chemicals Order Form

University Research Chemicals Order Form
Submit your request to order chemicals for university research purposes. Please complete all sections to ensure timely processing and compliance.
Full Name of Requester
First NameLast Name
University Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Department or Laboratory Affiliation
Supervisor/Principal Investigator Name
First NameLast Name
Project or Research Title
Intended Use of Chemicals (Brief Description)
Select Chemicals to Order
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Name: A to Z
Name: Z to A
Price: Low to High
Price: High to Low
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Acetone
Solvent, analytical grade
$25.00QuantityBottle Size

Ethanol (Absolute)
High purity ethanol for laboratory use
$35.00QuantityBottle Size

Sodium Chloride
Reagent grade NaCl
$10.00QuantityPackage Size

Hydrochloric Acid 37%
Reagent grade, for laboratory use
$30.00QuantityBottle Size

Custom Chemical Request
Specify chemical name, grade, and quantity in the comments below.
FreeQuantity

Total
$0.00
Delivery Location (Building and Room Number)
Expected Date of Use
MonthDayYear
Date
Upload Safety Data Sheet (SDS) if Available
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Signature of Requester (for Authorization)
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