Chemical Maintenance, Inc.

        1100A West Bloomington Road, Champaign, Illinois  61821

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Order Form

Please list supplies you wish to order.  All items will be processed at current catalog prices unless you have an established account and discount agreement.  There is no charge for shipping and handling for any order with a value of $30 or more.

  • Please provide ordering information including number and packaging ( 3 cs, 4 gal, 2 pl) as well as product name (Swift, Super 100 Plus, etc):

    QTY PRODUCT NAME

    BILLING INFORMATION
    Purchase Order #
    Account Name

    SHIPPING INFORMATION
    Street Address
    Address (cont.)
    City
    State/Province
    Zip/Postal Code

Copyright © 1999 [Chemical Maintenance, Inc]. All rights reserved.
Revised: December 15, 2008