Inquiry Form

Inquiry regarding our Products

Thank you for your interest in EIKEN CHEMICAL and our products.
Please completely fill out all necessary information on the following inquiry form.
If you would like to place an order, please include Product Name, Product Code Number (if known), Quantity, and Billing/Shipping Address (if different).
We will contact you as quickly as possible depending on the nature of your inquiry .

All your information is kept private and confidential, and not given to any third party.
First Name
Last Name
Title/Suffix
Company Name
Country Name
Zip Code
Address

Billing Address
(if different)

Shipping Address
(if different)
Phone Number
Fax Number
E-mail Address

Product Code Number

Product Name
Order Quantity
Inquiries
Required fields
Note: Our response might be delayed during the Japanese holidays.