Sample Request Form

We may require payment for processing and shipping sample requests. Most items available online do NOT ship from the same location, so when requesting multiple samples, each may require its own shipment. All samples are non-customized, random samples and are intended for your company to use in evaluating a product’s purchase.

Name

Company

Product ID

Referral Info Enter the sales representative or promo code you were referred with.

Address

City

State / Province

Zip / Postal Code (no spaces)

Shipper Number

Email Address A confirmation email will be sent to this address.

Phone Number

Product

Event Information

In-Hands Date Date Provide your event date or firm in-hands date if applicable.

Notes

* Above information needs to be filled out entirely in order for your sample request to be processed.