KIMTECH SCIENCE* STERLING* Nitrile Glove Order Form
*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 the box of STERLING* Nitrile gloves you requested.

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:

*GLOVE SIZE:   X-Small   Small   Medium   Large                             X-Large  


 *   Fields marked with an asterik (*) are required.
   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
   How did you hear about us? (Check all that apply)
e-newsletter- The Science Link
e-mail
Direct mail via USPS
Advertising
Word of mouth
Sales Representative
Love That Glove Promotion
   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)
  
  


Quantities are limited.
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