Stock Sample Request Form
Please Note All Sample Requests are sent standard UPS Ground Service from LC. Additional Charges apply for expedited requests
Sales Rep Name
*
Email
example@example.com
Customer Sample is For
*
Sample Item Requested
*
Quantity Requested
*
For case quantity samples send through Customer Service to place no charge order
Sample Item Requested
Quantity Requested
For case quantity samples send through Customer Service to place no charge order
Sample Item Requested
Quantity Requested
For case quantity samples send through Customer Service to place no charge order
Sample Item Requested
Quantity Requested
For case quantity samples send through Customer Service to place no charge order
Address to Send Sample
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is Expedited Shipment Required? Additional cost applies
Yes
Special Instructions
Submit
Should be Empty: