Case Study Entry Form


Share Your Amphomag® Story and Receive a Free Gift!

We are creating case studies to share with current and potential customers of Amphomag®. Please complete the form below with as much insight and data you can provide regarding your situation with our product.

Also...your completed and approved case study will be featured with your company logo in our marketing materials and website.  A great way to promote your company for free!

Did we mention the gift?! As a token of our appreciation for your time, we will send you a gift after we receive and validate your case study entry.



Overview

How did you first hear about Amphomag? *
 


*If you selected Media, Recommendation, or Other, please provide more details.
 


What types of chemicals do you handle at your facility? Check all that apply.




Please list the types of chemicals in detail.
*  

Is there a specific regulation(s) to your industry you are in compliance with thanks to Amphomag?




Please explain how you are compliant with the regulation(s).
 




Benefits of Amphomag

What are the top 3 features you love about Amphomag? (e.g. easy to use, pH color indicator, one solution for all spills, easy to store)
*  

How has Amphomag's universal properties to absorb and neutralize all spills benefited your operations in the following areas?

Safety
 

Productivity
 

Financially
 

Other
 



Before Amphomag

What tactics did you try before you started using Amphomag?
*  

What were the results of the tactics?
*  


What was the big "a-ha" moment when you decided you need to try Amphomag?
*  



Thanks to Amphomag

Did you experience any direct "big win" business results for your company because of Amphomag? (e.g. reduced waste disposal fees 20%, awarded safety award, reduced operating costs 20%, improved work safety by 15%)
*  

Quotes: Use one or two quotes to provide additional interest and perspective to your case study.
 



Recommendations

What is the single biggest reason you would recommend Amphomag?
*  

Is there any trade association or group specific to your industry that Amphomag should consider advertising options?
*  



Contact Information

Full Name
*  

Title
*  

Email Address
*  

Phone Number (office or cell)
*  

Company/Organization Name
*  

Street Address 1
*  

Street Address 2
 

City
*  

State: *
 

Country: *
 

Number of Company Locations
*  

Company Size *
 

Industry Type *
 


By submitting a case study, the entrant authorizes and agrees that they will be deemed to consent to:

a.) the use for promotional and other purposes (without further payment and except as prohibited by law) of their case study, name, organization, city/town/country of residence; and

b.) participating in the Promoter’s reasonable marketing and promotional activities, including the use of the entrants comments in any media, including reproduction for print and online; and

c.) the entrant agrees that all rights including copyright in all works created by the entrant as part of the case study entry shall be owned by Amphomag® and Premier Magnesia absolutely without the need for any payment to the entrant. They further agree to waive unconditionally and irrevocably all moral rights pursuant to the Copyright, Designs and Patents Act of 1988 and under any similar law in force from time to time anywhere in the world in respect of all such works.

d.) receiving newsletters and unsolicited emails, from us by email from time to time. If you do not wish to receive future emails, you may unsubscribe from the mailing by following the instructions given at the bottom of any such email. We do not share your personal information with other companies for their marketing purposes. We sometimes use other companies to deliver emails from Amphomag® on our behalf, but we will not allow them to use your details for anything else.