Check the boxes that apply Check the boxes that apply Send me a complimentary sludge/grease sample kit On receipt we will fill with 32oz of sample material and return to Spectrum Water for testing at no charge or obligation to buy We understand that Spectrum will match one of 30 polymers to our application for enhanced performance/price/customer service

Company/Municipality

Contact Name

Phone Number/Extension

Phone Number/Cell

Email Address

“FREE” Polymer Sample Kit Shipping Address

City

State, Zip Code

We use polymer for (check one): We use polymer for (check one): Bio Waste Grease Combination of Grease and Bio Waste Other

If you selected "other", please explain

Volume of effluent treated per week/month: (Example:10 GPM)

Number of polymer 5 gallon pails we purchase

Number of polymer 55 gallon pails we purchase

Number of polymer 275 gallon pails we purchase

Each (check one): Each (check one): Week Month Quarter Year