Pharmaceutical Ingredients

Thank you for your interest in our products. Please fill out the form below and submit it to us.
Once you submit this online request form, person in charge on your request in Hayashibara Co., Ltd. or our affiliates will contact you.

Inquiry & Sample Request

  • step1
    Provide information
  • step2
    Confirm
  • step3
    Submit
NameRequired First name
Last name
EmailRequired
Confirm email.
Phone - -
Company nameRequired
DepartmentRequired
Address Address1(Room#, Building)

Address2(Street, City)

State/Province

Zip code/Postal code

CountryRequired
Comment or inquiryRequired
Sample Request Please click the sample you request.
  • HPLE (High Purity Low Endotoxin) Products
  •  
  •  
  • Products for Oral use
  •  
  •  
  •  
Handling of personal informationRequired
Terms regarding personal information
Please read and acknowledge the following terms regarding personal information when using this request form.

1.Privacy Policy of this Website
Please refer to the Privacy Policy for information on Hayashibara's efforts to protect personal information collected on this Website.

2.Purpose
Personal information obtained through the contact forms is used for answering inquiries, shipping items, providing after-sales service, and informing new products/services.

3.Request regarding Personal Information
Please contact Personal Healthcare Division for disclosure, correction and deletion of Personal Information, using this form. Hayashibara shall respond your request appropriately.