SHAMROCK MINING & METALS
Name
Title
Organization
Email Address
Delivery Address
City, State Zip
Phone Number
Reason for
Request
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Please clearly define
testing procedure and
evaluation criteria.
All samples are to be used for testing purposes with the intent of evaluating this material for the use
in standard operations. The information gathered from testing is for internal discussion only and may
only be discussed with Shamrock Mining & Metals and the above referenced company, unless prior written
approval is obtained from Shamrock Mining & Metals. Furthermore, the above referenced company
agrees to share all test results obtained through the evaluation process with Shamrock Mining & Metals.
By completing this sample request form, the requesting party assumes the responsibility of informing all
individuals involved of these conditions of use. It is the responsibility of the requesting party to ensure
no samples are handled or evaluated by any parties not agreeing to these conditions of use. Unused
sample material must be returned to Shamrock Mining & Metals or be disposed of appropriately and may
not be used by any other organization or individual.
© 2004 SHAMROCK™
Mining & Metals LLC.
All rights reserved.
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