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Complete the Product, Information required, Contact and Vessel sections.. The more information about the product you can provide, the more likely is a successful result.. Print the form

Complete the Product, Information required, Contact and Vessel sections The more information about the product you can provide, the more likely is a

successful result You can edit fields to make changes or use the RESET button at the bottom of form to start again

Print the form and send it by post or fax to:

Wreyland Systems Ltd Facsimile: +44 (0)1803 814111

PO Box 86, Totnes, TQ9 6ZA, UK

Product Details

Shipping name or

Proper chemical name

Trade name Abbreviated name

CHRIS Code

UN Number CAS Number Producing Country

Producer

Producer contact details:

Telephone

Fax Email Loading Port Loading Terminal (if different to producer)

Information required

Select as required :

Wall wash requirements

(tank cleanliness) Yes Cleaning after discharge Yes

Spill or contamination

details Yes Any other details required

(please specify)

Contact Details

Name Company Address

Postal Code/ZIP

Country Telephone

Fax Email CAPIS serial number

(if any)

Requested mode of reply Email

Telephone Fax (a charge will apply) Post

Vessel details

Ship name Masters name Telephone

Fax Email

Do you require results to be

sent direct to the Master?

Yes No

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