Order Form - Superior Materials | Specialty Chemical Distributor

To place an order during normal business hours, please call 516-222-1010. Orders are also accepted via fax, at 516-222-1332.

You are welcome to place an order using the following form. Existing customers may skip fields for information that we already have. New customers: please be aware that orders are subject to normal new-business verification procedures. In any case, if you have not received a confirmation from us within one business day, please follow up by e-mail or phone to be sure that the order was properly transmitted.

1. Please provide the following contact information (* required).

Your Full Name *

Title

Organization *

Billing Address

City

State/Province

Zip/Postal Code

Country

Work Phone *

Email *

2. Please provide the following ordering information:

PO DETAIL INFORMATION

Purchase Order #

Required Delivery Date

Enter Quantity, Unit, Description (include your codes, if any)

Enter Quantity, Unit, Description

Shipping Information

Street Address

City

State/Province

Zip/Postal Code

Country

Select One Option from the Dropdown:

Ship via (carrier name)

Special shipping instructions (e.g. carrier instructions, packing instructions, marks, freight billing instructions, palletizing requirements, etc.):

Other information or questions (e.g. pricing information, technical data required, lead-time questions, etc):

5 + 2 = ? Please prove that you are human by solving the equation *

* We acknowledge all orders within one business day with a return e-mail or phone call. If you have not heard from us within one business day, please contact us to be sure we have received this order.

Shipping Information

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