Gel Time Extender Sample Request Form Name Company Email Address Phone Number Shipping Address City State Zip Please select which sample kit you are requesting Please select which sample kit you are requesting 1 x 6 pint case of 36GELX Duratec Potlife Extender Terms & Conditions Terms & Conditions By checking this box and submitting this form, I acknowledge I am consenting to receiving communications via phone, text message or email from Hawkeye Industries regarding the product samples being provided. I understand that in exchange for the complimentary product, I am expected to provide honest feedback of my experience. SUBMIT