LANXESS Beverage & Food Sample Submission

Nagardo®
Velcorin®

Customer Information (* required fields)


Analysis















Beverages & Samples

Beverage instructions

Every beverage, every flavour, every new dosage is listed as a separate beverage!

Each bottle gets its own line!


Please Review Your Information

Customer Information

First Name:

Last Name:

Email:

Company:

Address:

City: ,

Country:

Analysis

Product:

Type:

Analysis:

Beverages & Samples

Product #1:

Production date: 2026-06-10

Site:

Dosing Unit:

CO2: No

Packaging:

Samples
Sample Type Description Batch/Lot

Please review all information above before submitting your form.