Sample Request Form
Samples
ATTENTION DISTRIBUTORS:  You can receive samples for your testing or demonstration purposes, or have them sent directly to your customer.  Please ensure testing is done under actual conditions of usage to assure required performance. IF WE SHIP TO YOUR CUSTOMER, DATA LABEL WILL NOT BE IDENTIFIED IN ANY MANNER!
Your Information:
Customer #:
(Required) Company Name:
(Required) Your Name:
Address:
City:
State:
Zip:
(Required) Phone #:
(Required) E-mail Address:

Unless otherwise specified, all samples are shipped via First Class Mail.  If you desire another method of shipping, please provide your account number for the carrier of your choice;  if you are a current customer, we can bill the charges to your Data Label Account.

Ship To:
How To Bill
Company Name:
Ship Via:
Carrier Account #:
 
Attention:
Address:
City:
State:
Zip:

Sample Items To Send
Please Refer To our Online Catalog For The Stock Item Numbers.
(Required) Item 1:
(Optional) Item 2:
(Optional) Item 3
(Optional) Item 4
(Optional) Item 5
(Optional) Item 6
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