Samples Order Form 

Thank you for your interest in Townsend Products. Our mission is to offer responsible, reliable and affordable solutions in water technology. So that we may better serve your needs, please take a moment to answer a few questions for us. One of our representatives will contact you about our products and samples will be sent for your consideration.

Name
Position or Title
Company
Address
Address
City
State
Zip
Country
Phone
Fax
Email
 

Please describe the type of business this product will be used for:

 
What product applications are you interested in? Check all that apply.
 

 Membrane Cleaners
 Anti-scalants
 Waste water coagulants
 Polymers
 Emulsion breakers
 Sponge balls for membrane restoration
 Mud removers
 Metalworking products
 Odor control agents
 Lubricants
 Floor coatings
 Janitorial chemicals

  

Townsend Products also offers consultation services to address your water technology concerns and help with membrane cleaning and restoration. Would you like to speak to one of our representatives about these services?

 Yes            No

  

Are you interested in becoming a distributor for Townsend Products?

 Yes            No

  
  
 
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