Proposal Form for Raw Materials

Please fill out the following form, and click on the CONFIRMATION button to check your form.
Please write in boxes with an asterisk.

1) The item you propose *

2) Its composition or general name *

3) Name of the manufacturer of the item *

4) Price (estimated) *

5) Features

6) CAS Registry No.

7) Other information

Your company name *

Your department / section *

Your name *

Your e-mail address *

Your phone number *

Your fax number *

	We will deal with your personal information in accordance with our company's Information Privacy Statement.
	To safeguard your personal information, we use Secure Socket Layer (SSL) which is a protocol independent transport layer for sending encrypted information.
	We will respond to your inquiries promptly. However, if you contact us by using the Mail Form link after business hours, on weekends or during holidays, we may not be able to respond promptly. (Note: Please note our local time is GMT +9:00)