Contact Us

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


    • Web Button_Request Quote

Education Customer Questionnaire

Welcome to the AquaPhoenix family! Please take a moment to fill out our Customer Questionnaire. This form captures all the information needed to set you up with an account and helps to ensure that we get in touch with the right people in your organization. Don’t hesitate to reach out to us if you have any questions at (866) 632-1291 or

1. Institution

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.


Shipping address is the same as billing address.


Purchasing address is the same as billing address.

Additional Contact

3. Additional Information