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Chemical Shipping Request Form

Please complete the form below to make a request for chemical shipment.Please allow us two business days to start your request.

Please contact Ted Reising at (314) 362-5732 for further inquiry.

Due to an increase in the number of chemical shipping requests, it may take up to two weeks to complete your shipment. Please plan accordingly.
CONTACT INFORMATION
Full Name:
Please enter your name
Phone Number:
Email:
Please enter your e-mail
PI Full Name:
Please enter PI's Full Name
Department Code:
Please enter your department code
Lab Location Campus:
Please select lab location

Building:
Please enter lab building name

Room#:  
Please enter lab room number
Lab Mailing Address
Campus Box#:
Please enter a campus box number

City:   
Please enter lab City

State:
Zip:    
Please enter lab zip
FedEx Account#:
Please enter a FedEx Account#
CHEMICAL/PACKAGE INFORMATION
Chemical Description:
Please enter chemical description
Concentration:
Please enter chemial concentration
Quantity:
Please enter Chemical Quantity
Volume/Size
Quantity Per container/package:
Container/package Type: (Example:3 x 50 mL conical tubes)
Require dry Ice: Yes    No
Note:
SHIPPING INFORMATION
Receiver/Business Name:
Please enter Receiver/Business Name
Address line 1:
Please enter Receiver Address
Address line 2:
City:
Please enter Receiver City
State:
Province:
Zip:
Please enter Receiver zip
Country:
Phone:
Return Authorization#: (Optional)
Certification Statement
By completing this Chemical Shipping Request Form, you certify that all chemical constituents in the shipment are listed and concentrations are accurate. Failure to do so can result in federal fines and penalties.
Accept
Please Accept Certificate Statement to proceed