Customer Service Profile
D.W. Davies & Co., Inc. is committed to supply to the specialty chemical marketplace the highest quality products and technical service available. So that we may best suit your needs as our customer, please take the time to complete the customer service questionnaire below. The information you supply us will be kept strictly confidential.

Please complete and submit this form now. A printable copy of this form is available for mail or fax to us as well. Thankyou!
Company/Organization Name
Address Line #1
Address Line #2
City State Zip
Primary Contact Name Job Title
Phone Fax
Email
Website Address (url)
Please describe the primary nature of your business or organization:
We commonly use the following types of products: (please check all that apply)
Aerosol Products Industrial Chemicals
Aircraft Products Institutional Products
Automotive Products Insecticides
Concrete Maintenance Products Janitorial Products
DC-99 Cleaner -Degreaser-Wax Stripper Lubricants, Greases & Oils
Enzymes Sanitation Products
Equipment Swim Pool Products
Food Service Products Transportation Products
Ground Control Products Water Treatment Chemicals
Housekeeping Products
We prefer to receive Davies products updates and announcements by: (please check all that apply)
Mail
E-mail
Fax
Phone
Thanks for completing our questionnaire!
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D.W. DAVIES & CO., INC. 3200 PHILLIPS AVENUE  RACINE, WI. 53403 
QUESTIONS? Call us at (262) 637-6133 or 1-800-888-6133