Client Login
Friday, May 16, 2008
Online Ordering Form
Learn More
Site Evaluation
Online Ordering Form

This online order form is designed to increase the convenience of ordering Regenesis products. To place an online order follow the 4 steps listed below:

  1. Completely fill out the form below (all fields must be entered). If you have any specific requests or comments please include them in the "Comments" box. When finished, press "Confirm Order."
  2. Review your order to make sure all information is correct and ready for submittal. If correct, click "Submit Order." If any information is incorrect, click "Change Order" and make the necessary changes.
  3. When you press "Submit Order," your order will be placed with Regenesis Online Services. You will receive an e-mail confirmation that we have received your order within about 48 hours. You will then receive a follow up call to verify and acquire any additional information we may need to process your order.
  4. If for any reason you do not receive an email confirmation and follow up call from Regenesis, we urge you to call our order desk at (949) 366-8000 to verify your order.

Important Note: Due to the technical and specific nature of our products our order desk will need to contact you early in the ordering process. Thank you in advance for your cooperation and patience.

Step 1: Customer Information
First Name:
Last Name:
Site Name:
Company:
Address:
Suite/Unit#:
City: (ex: San Jose)
Country:
State / Province:
Zip / Postal Code:
Phone:
Email:
Questions / Comments:
Step 2: Product Information
Oxygen Release Compound (ORC): lbs. (Minimum Order Requirement = 60 lbs.)
Advanced Oxygen Release Compound (ORC Advanced): lbs. (Minimum Order Requirement = 50 lbs.)
Hydrogen Release Compound (HRC): lbs. (Minimum Order Requirement = 150 lbs.)
3-D Microemulsion (3DMe)™: lbs. (Minimum Order Requirement = 390 lbs.)
Hydrogen Release Compound Extended (HRC-X): lbs. (Minimum Order Requirement = 150 lbs.)
RegenOx: lbs. (Minimum Order Requirement = 1,080 lbs.)
Metals Remediation Compound (MRC): lbs. (Minimum Order Requirement = 150 lbs.)
Bio-Dechlor INOCULUM (Dechlorinating Microbes): Liters (Minimum Order Requirement = 15 liters)
ORC Filter Socks: 2-inch: (Minimum Order Requirement = 12 socks)
4-inch: (Minimum Order Requirement = 10 socks)
6-inch: (Minimum Order Requirement = 8 socks)
ORC Advanced Filter Socks: 2-inch: (Minimum Order Requirement = 12 socks)
4-inch: (Minimum Order Requirement = 10 socks)
6-inch: (Minimum Order Requirement = 8 socks)
Not Listed/Other:
Desired Arrival Date (month/day/year):     
Pricing Note: To avoid confusion between domestic and international pricing we do not post current pricing on our website. Our order desk will gladly provide current pricing during their confirmation of the order. Our order desk can be reached at 949-366-8000.

If you have any problems with the ordering system or questions about specific fields, feel free to call the order desk at (949) 366-8000 for assistance.