Group Pujol International - Manufacturers' Representative for Industrial Chemical Raw Materials

Product Order/Information Form

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This form will be sent directly to our offices at Grupo Pujol Internacional. To correctly process your submission, we need you to provide as much information as possible. Fields marked with * (asterisk) indicate required data.

If you wish to contact us directly at our office, we will be glad to offer you our services at:

Grupo Pujol Internacional
P.O. Box 5779-1000, San José, Costa Rica
Phone: +506 272-8668
Fax : +506 272-3428
E-mail: grupujol@racsa.co.cr

(1) Requestor Information

*Company

*Contact Name

*Country

*State/Province

*City

*Zip/Postal Code

*Street Address
(no P.O.Box
please)

*Phone Number

Fax Number

E-mail address

(2) Detail of Request

*Information
and/or
Products
desired

Item		Quantity



Time Frame:

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