Product Sample Request Form

Thank you for considering Horsehead Corporation as a provider of your zinc oxide & zinc dust needs. Please complete this form to request a sample. Items marked with an asterisk (*) are required. We cannot ship to PO boxes, so please provide the actual street address. If you need assistance in selecting an appropriate grade for your application, please call the Technical Service number. We are very interested in learning how our products perform in your application and will follow-up with a phone call in a few months after sample shipment. Your cooperation in responding to our inquiry will be appreciated.

Company Name*		Contact Name*
Address (line 1)*		Address (line 2)
City*		State/Country*	Postal Code*

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Phone Number*		Fax Number
Email*
Product/Grade Requested* (Note: std. Sample size is 2 lbs.)
Application/ End Use	Annual Usage	Current Supplier/Product

If you are a distributor requesting a sample for your customer, please complete the following to receive a send confirmation when sample ships.
Distributor Name		Distributor Email
Shipping Note: samples will be shipped UPS Ground If request form cannot be sent electronically, please fax completed request to 724-773-2269 Technical Service: 724-773-9062 Sales Assistance: 724-773-2271 Customer Service: 724-773-2235 or 724-773-2296