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SEFA Chemical Compatibility

Air Science^® requires that you complete the following questionnaire when buying a ductless fume hood.

Complete the form below and submit online, or download a copy to print-out and submit via FAX. Complete and return to us via Toll-Free FAX USA 800-306-0677, or 239-489-0922.

If you have questions or need assistance please contact your laboratory safety officer or contact customer service Toll-Free USA 800-306-0656, 239-489-0024.

* Required Field

About You (Person Submitting Quotation Request)

First Name*

Last Name*

Title*

Facility/Institution*

Building/Room Number

Street Address

Street Address 2

City

State

Zip

Contact Information and Contact Preference

Phone Number*

Fax Number

Email*

How Would You Like To Be Contacted?*

Phone
Email

Intended Chemical Applications (Per SEFA-9-A Format)

Column 1: Material ID Number
Column 2: Amount
Column 3: Concentration
Column 4: Temperature
Column 5: Container
Column 6: Frequency
Column 7: Comment

Material ID Number	Amount	Concentration	Temperature	Container	Frequency	Comment

Comments

Certification by Person Submitting Form

By typing my initials, certify that in my capacity as (your position in the company/facility/institution) in (company/facility/institution) I believe to the best of my knowledge that all data and information submitted in this Chemical Applications Questionaire, form Air Science SEFA-9-A is truthful and accurate and that no material fact has been omitted.

Initials

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