First Name:

Last Name:

Position:

Company:

Mailing Address:

Shipping Address:

City:

State:

Zip Code:

Phone:

Fax:

Your email:

I learned about Gum Technology via:

Date needed by:

Sample will be shipped via ground service. If you need second day or next day service, please provide your UPS, DHL or FedEx #:

Please complete the following information so that we may be able to suggest an appropriate sample.

What functionality is desired in your product?
(thickening, suspension, emulsification, etc.)

What is your final product/application (sauce, bread, tortilla, etc):

Final food form:
(e.g. frozen, retort, aseptic, refrigerated, dryshelf, etc.)

High Acid (pH < 4.5)
Low Acid (pH > 4.5)

Are any of the following available for mixing with gums?

Oil
Sugar
Salt
Propylene Glycol
Alcohol

Any special requirements?

Natural Only
Organic
Kosher
Other:

Is the product heated?

Yes No
Processing Temp (degrees F)?:

Machinery available for gum incorporation (e.g. Lightnin' type blender, Bredo Likwifier type blender, aspirator, swept surface kettle, etc.)

Comments and Questions: