Fenner Chemical LLC Hazardous Chemical Liability Release Form

In order to Purchase any Hazardous Chemical from Fenner Chemical LLC, this form must be read, filled out and returned to Fenner Chemical LLC:

As a purchaser or future purchaser I agree and understand the following:

• I understand that Sodium Hydroxide (NaOH) and Potassium Hydroxide (KOH) and other chemical purchased from Fenner can be or are hazardous

materials and have the potential to create highly reactive chemical reaction that may be dangerous or harmful if misused.

• I am not purchasing this item for any illegal use or purpose.          
• I certify that I am at least 18 years of age
• I will use this product in a manner that complies with all local, state, and federal laws.
• Fenner Chemical LLC will not ship any orders without having received agreement to these terms.  (Purchases from non-complying buyers will be cancelled)
• Should litigation arise from the use or misuse of this product, the undersigned agrees to hold harmless Fenner Chemical LLC, its agents and suppliers. 
• This Chemical Liability Release Form will be governed by and construed in accordance with the laws of the State of Michigan, without giving effect to its conflict of laws provisions of the actual state or country where the product was used.
• All parties agree to submit to the personal and exclusive jurisdiction of the courts located in Saginaw County, Michigan.

I understand that I am purchasing and using these chemicals at my own risk. While using these chemicals I may encounter unavoidable risks or hazards where injuries may occur. I agree to release, hold harmless, and indemnify Fenner Chemical LLC, and their agents, from any liability for injury or damage that may occur in connection with the use of these chemicals. I intend this release and indemnification to be effective, regardless the type of legal recovery theory that may be chosen. I will make no claim or legal action against Fenner Chemical LLC or their agents, arising out of my use or misuse from chemicals purchased from Fenner Chemical LLC.   

I have read this release, and know that the Chemicals I am purchasing are hazardous chemicals, and dangerous. I will read the MSDS supplied before using any chemical.  By providing the information below by means of e-mailing, faxing or mailing this form to Fenner Chemical LLC I am accenting to the terms of this agreement, which means I will not hold Fenner Chemical liable for any misuse of any chemical or product Fenner Chemical has sold or provided to me. 

*** Please be sure to use the correct address when returning this chemical release (to ensure your form is received timely and prevent refund for non compliance), send to

E-mail: ChemRelease@FennerChemical.com       Fax: 1-866-840-3875

Mail: Fenner Chemical    PO Box 52, Melvin, MI 48454

Full Name:  _____________________________________________

Your Email Address:  ______________________________________                     

Address:  ________________________________________________

City:  _____________________ State:  _________ Zip Code: ­­­­­­­­­­­­­­­­_______________________

(Not available to Alaska or Hawaii)

Telephone (include Area code):  _______________________________                  

I am 18 years of age or older:      _________________________________

Intended use for Chemical Purchased: ___________________________