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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*
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 DHL Ground
If request form cannot be sent electronically, please fax completed request to 724-773-2269

Technical Service: 724-773-9389
Sales Assistance: 724-773-2271
Customer Service: 724-773-2204