Fragrance Formula Sheet

Instructions: Provide all of the information requested in this sheet for the fragance formula.
An example of a completed sheet is provided below, followed by a blank sheet for your
submission.

EXAMPLE OF A FILLED-IN SPREADSHEET SUBMISSION

Provide the Following Information:

Fragrance Name as
reported on CSF: Fragrance XYZ
Company Name: ABC Fragrance Company
Contact: Tom Jones
Address: 2343 Street, Washinton, DC, 20006
Phone: XXX-XXX-XXXX
Fax: XXX-XXX-XXXX
Email: tjones@abcfragrancecompany.com

Provide the Following for Each Chemical in the Fragrance

CAS number Chemical Name of Fragrance Ingredient
25265-71-8 Dipropylene glycol (isomer unspecified)
8000-48-4 Eucalyptus oil (Eucalyptus globulus Labille)
119-36-8 Methyl salicylate

Fragrance Formula Sheet

Provide the Following Information:

Fragrance Name as
reported on CSF:
Company Name:
Contact:
Address:
Phone:
Fax:
Email:

Provide the Following for Each Chemical in the Fragrance:

CAS number Chemical Name of Fragrance Ingredient