Specified Metals Sample Registration
***THIS IS NOT A SAMPLE REQUEST FORM***
If you would like to request sample binders please copy and paste this link into your browser. http://specifiedmetals.com/samples.html

Thank you for your interest in Specified Metals. In order to provide you with the most up-to-date samples and information please complete the following form UPON RECEIPT OF YOUR SAMPLES.


***DISTRIBUTORS/REPS***
Please complete the following form when samples are sent out to your customers and prospects. Before ordering more binders, all previous binders must be accounted for via online registration.

Customer Email Address *
Your answer
Distributor Name (if applicable) *
Please name the distributor or rep who sent the samples or type "N/A" if you did not go through a distributor.
Your answer
Company Name *
Your answer
Name *
Your answer
Address *
Your answer
Telephone
Your answer
Sample Type *
if more than one type please list in "other" category
Submit
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