ChemAssociates				Product Inquiry
							Date: _________
			From:
	Company Name		______________________
	Contact Name		______________________
	Street Address		______________________
	City, State, Zip		______________________
		Phone:	______________________
		Fax:	______________________
		Email:	______________________
Quantity			Description			Requesting Shipping Quote?		Price (if known)
						Yes	No
						Yes	No
						Yes	No
						Yes	No
						Yes	No
						Yes	No
						Yes	No
						Yes	No
						Yes	No
						Yes	No
						Yes	No
						Yes	No
						Yes	No
						Yes	No
						Yes	No
						Yes	No
						Yes	No
						Total
Special Requests: