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Lab Materials Disclosure Agreement

  • Due to health and safety concerns for you, our Associates, other users of the laboratory, your samples and our equipment, the laboratory requires the following before any materials will be received or processed in our laboratory facility;
    1. A list of all materials to be sent in to the lab must be recorded on the reverse side of this form. Materials must be identifiable with the same name as recorded on the reverse side of this form.
    2. All SDSs (MSDSs) must be attached to this form. Undersigned attests that SDS (MSDS) are complete and accurate and none have been omitted.
    3. It is the undersigned’s responsibility to remove, or have removed, all materials within five (5) working days after the lab has completed processing the materials. Materials CANNOT be stored at Black Bros. Co. after they have been processed in our lab facility.
    4. If the material is not removed within five days, Black Bros. Co. will return all materials to the attention of the undersigned at the address listed below. Black Bros. Co. will charge a $200 handling fee plus the cost of preparation and shipping. The invoice will be sent to the attention of the undersigned at the address listed below.

    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.

  • MM slash DD slash YYYY
  • List of Materials

  • Material Name or IdentificationManufacturerQuantitySize (Th. x W. x L., etc., core size) 
  • Material Name or IdentificationManufacturerQuantityPackaging SizeSDS / MSDS Number 
  • Black Bros Co

    501 Ninth Avenue
    PO Box 410
    Mendota, IL 61342-0410
    Phone: 815.539.7451
    Fax: 815.538.2451
    www.blackbros.com
    E-mail: [email protected]