Contact Us

    • AquaPhoenix Scientific Inc.
      860 Gitts Run Road Hanover, PA 17331
    • Local: 717-632-1291 Toll-Free: 866-632-1291


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Customer Questionnaire

Welcome to the AquaPhoenix family! Please take a moment to fill out our Customer Questionnaire. We tried to make it as painless as possible. This form captures all the information needed to set you up with an account. We will use this information to design your product labels, ship items to the right place, and get in touch with the right people. Contact us at (866) 632-1291 with any questions. Click here to download a PDF version of the Customer Questionnaire and Private Label Guide.

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    1. Company Information

    2. Contact Information

    Billing - Accounts Payable

    EmailDirect Mail

    ** If applicable, please provide us with a copy of your sales tax exemption certificate.

    TERMS: Our Standard terms are Net 30 for approved accounts. If you prefer, we can process payments at the time of shipping using Visa, Mastercard, Discover, or American Express. Please call the accounting department at 1-866-632-1291 to provide your credit card information.


    Purchasing address is the same as billing address.

    Additional Contact

    3. Private Labeling

    Would you like your AquaPhoenix manufactured reagents private labeled? YesNo

    If YES:

    Type the contact information that you would like to appear on your labels in the boxes below. This will default to AquaPhoenix contact information if left blank. This information is mandatory. Due to OSHA/GHS label requirements, P.O. boxes are not acceptable.

    Follow the logo requirements below for sending us your company logo. It's important that you provide us with a high-quality logo so that we can provide you with a printed product that you are proud to display.

    Logo Requirements

    • Logos should be minimum of 300dpi.
    • Acceptable formats include JPEG, PSD, and EPS.
    • DO NOT send logos that are in Word, Excel or Powerpoint.

    Example of a logo printed on a label:

    sample label

    We will email you a proof of your label for approval.

    4. Shipping Information

    If freight collect:

    LTL Billing Address:

    5. Additional Information