Industrial Chemical Product Liability Waiver Form
Please complete this waiver form if you are handling or receiving an industrial chemical product. Your responses will confirm your identity, intended use, safety understanding, and acceptance of the product liability waiver.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Company or Organization (if applicable)
Product Name or Identifier
*
Intended Use or Handling Description
*
I acknowledge that I have received and understood all relevant safety instructions and material safety data sheets (MSDS) for the industrial chemical product.
*
I acknowledge and understand the safety instructions.
Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit Waiver
Submit Waiver
Should be Empty: