Sample Request Initiation Form

Please fill out the form to request a sample for your customer. After filling out this form, a unique link will be sent to your customer to formally request a sample.

BioSphere Plastic LLC
4804 NW Bethany Blvd
STE I-2, 233
Portland, Oregon USA 97229-4982

+1 503 530 8674 [email protected]

BioSphere Plastic LLC
4804 NW Bethany Blvd
STE I-2, 233
Portland, Oregon USA 97229-4982

+1 503 530 8674 [email protected]

1Agent Information

2Customer Information

3Sample Information

4Notes

Agent Company Name(Required)

Agent First and Last Name(Required)

Email(Required)

Customer Company Name(Required)

Customer Contact Name(Required)

Customer First Name Customer Last Name

Customer Email(Required)

Customer Phone Number(Required)

Customer Country(Required)

Sample Type Requested:(Required)

1 kg BioSphere 201 (J) Additive (pellet form)

1 kg BioSphere 202 Additive (pellets for clear PET – extruded, thermoformed, and BOPET)

1 kg BioSphere 203 Additive (pellets for clear PET – blow molding/injection molding)

1 kg BioSphere 302 Additive (liquid form)

500 g BioSphere 401 Additive (powder form)

Polymer Type(Required)

The base resin used to make the final product.

Product Application(Required)

The final product that is made.

Special Instructions

Use this field to notate any additional comments. Notate if the customer needs more than 1 KG (please refer to sample request policy).

Date(Required)

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Sample Request Initiation Form

Week Completed