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Company

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BOX REQUEST

I have read and accept the privacy policy *

I agree that Diachem S.p.A. use my personal information to manage my request for quotation *

I agree that Diachem S.p.A. use my personal data for the sending of information, communications and commercial offers, initiatives, newsletters, advertising and information, through any means, including interactive, by Diachem Spa and its subsidiaries and / or affiliates.

I agree that Diachem S.p.A. use my personal data for the preparation of studies and statistics on sales, customers and other information by Diachem Spa and / or authorized third parties.

All fields marked with an asterisk * are required

All fields marked with an asterisk * are required

Company

Company Name *

Street adress *

Contact person

Full name

Your email *

Phone number *

CAMPI PREIMPOSTATI

Offer:

choose one or more options and fill in the fields

 Formulation
amount in LT / KG
 Packing
amount in LT / KG

please specify:

type primary packaging ((for ES: vial, bottle, bottle, canister, bucket, IBC, water-soluble bags, jars, sachets, bags coil, paper bags, big bags, …))

size in primary packaging LT / KG ((for ES: LT1, KG10, …))

primary packaging material ((for ES: PET, COEX, aluminum, polyethylene, paper, …)

silkscreen primary packaging:  printed /labeled

case:  Yes No

leaflet:  Yes No

scoop:  Yes No

carton:  Yes No – pz per carton ((for ES: 10pcs per carton = cardboard from LT1 LT10)

screen printing carton:  printed /labeled

LT/KG per pallet

h max pallet

other (specify. For ES: saves baby cap, tamper evident, induction sealing, …)

 R & D (development formula, pilot production, …) (specify)

 NOT standard analysis (specify)

 other (specify)

2. Type of formulated:

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 EC SL SC EW WP DP GR SG WG

 other (specify)

3. Type of finished product::

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 crop protection fertilizer PMC

 other (specify)

4. Commercial product name:

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(specify)

5. Active Ingredient:

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 herbicide insecticide fungicide fertilizer other

(specify)

name / names active ingrediente &% w / w

(for ES: Deltamethrin 1.51% = 15.70 g / LT)
(for ES: Copper -sulphate tribasic copper 24,00% (= 360,00 g / L))
(for ES: Tefluthrin 0.50%)

6. Recipe (only deals formulation and / or R & D):

choose an option and fill in the field

 you have the recipe you want Diachem to develop the recipe

if you have the recipe

Write recipe

(Write recipe)

Charge recipe file (word / pdf)

7. Registration:

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 in progress obtained

if obtained indicate:

number:

Date:

Location:

8. Authorized site:

choose an option

 Diachem site is already empowered to formulate and / or package the product request

 Diachem site has NOT authorized to make and / or package the product request

if Diachem has NOT authorized site, choose an option

 I need a letter of acceptance to formulate / pack by Diachem

 I do not need the acceptance letter

9. Full Service / Account work:

choose one or more options and fill in the fields

 I require "full service"

 at my charge packing materials (specify)

 at my charge labels (specify)

 at my charge active principles (specify method of delivery. For example: ATB, drums, IBC, 25KG bags, …)

 at my charge coformulants (specify method of delivery. For example: ATB, drums, IBC, 25KG bags, …)

 at my charge others (specify)

10. Timing:

fill out the field

the services is required for (writing as to when it needs to be carried out the service)

Attachments:

if available, charge the following documents, it can be extremely useful to evaluate your project and to undergo our best quotation

load finished product MSDS

load SPECIFICATIONS finished product

load MSDS active principles, coformulants, …

load Manual Formulation

load more

I have read and accept the privacy policy *

I agree that Diachem S.p.A. use my personal information to manage my request for quotation *

I agree that Diachem S.p.A. use my personal data for the sending of information, communications and commercial offers, initiatives, newsletters, advertising and information, through any means, including interactive, by Diachem Spa and its subsidiaries and / or affiliates.

I agree that Diachem S.p.A. use my personal data for the preparation of studies and statistics on sales, customers and other information by Diachem Spa and / or authorized third parties.

All fields marked with an asterisk * are required