*Offer available only to laboratory and cleanroom professionals who are residents of the 50 United States, District of Columbia or Canada (except the Province of Quebec).
 Please fill in the information below and Kimberly-Clark will send you our new Lab Care Products

CONTACT INFORMATION
SHIPPING INFORMATION        same as Contact Information
*First Name:
*Last Name:
*Address:
Address:
*City:
*State:
*Zip:
*Facility:
*Title:
Other:
**Email:
**Phone:
 
*Facility:
*Attention:
*Address:
Address:
*City:
*State:
*Zip:
**Phone:

*I am requesting:      
KIMTECH SCIENCE* Product Demo Kit   
KIMTECH SCIENCE* Bench Top Protector   
KIMTECH SCIENCE* Lab Care Products   (Including Bench Top Protector, Lens Cleaning Wiper and Dusting System)   


 *   Fields marked with an asterik (*) are required.
**  Your email address & phone are needed if we need to contact
     you regarding your order. It will not be used for solicitation.
   How did you hear about us? (Check all that apply)
The Science Link
Kimberly-Clark Professional Website
Direct mail
Advertising
Word of mouth
Sales Representative
Product Package
   Do you work in a clean room or laboratory?       
 What products are you currently using? (Check all that apply)
KIMTECH* Brand Wipers Other (Please specify)
KIMTECH* Brand Gloves Other (Please specify)
KIMTECH* Brand Masks Other (Please specify)
KIMTECH* Brand Apparel Other (Please specify)
   Would you like to receive electronic updates on product upgrades and special offers from Kimberly-Clark?   Yes No
   Would you be willing to participate in online market research regarding related topics?   Yes No
  


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