I hereby attest that the list on the reverse side of this form is an accurate and complete list of materials I will bring in, or ship to, Black Bros. Co. for the purposes of conducting a lab trial. I have attached all SDS (MSDS) for all materials as appropriate. Additionally, I accept the responsibility to remove, or have Black Bros. Co. remove, all materials listed on the reverse side of this form. If I have not removed the materials in accordance with #4 above, I authorize Black Bros. Co. to return the materials and invoice the company named below a $200 handling fee plus the cost of preparation and shipping. I further attest that I have the authority to bind the company named below to this agreement.
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