GOT QUESTIONS? CONTACT KIM XAVIER
817-415-0957
CATALOG & SAMPLE PACK REQUEST FORM
By completing this form, you are requesting that a Scentsy Catalog and/or scent samples be mailed out to you.
Your Host or Consultant's Name (if you have been invited to a Scent Social or provided with a referral link for shopping)
First Name
Last Name
Your Name
*
First Name
Last Name
Email (Required so that you can track your package)
*
example@example.com
Address (PLEASE double check your address. Due to the expense of postage, packages that are returned due to incorrect address will not be resent)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone Number
*
-
Area Code
Phone Number
I am interested in receiving the following COMPLIMENTARY Scented Blessings. CLICK ALL THAT APPLY
*
Catalog
Party Pak with Deluxe Samples (Available to Scent Social Guests only)
New Season Scent Samples
Laundry Line Samples
Cleaning Product Samples
Body Line Samples
Pet Samples
Scent of the Month Scent Sample
What is your Facebook Name? Let's Be Friends! Send me a Friend Request. My Facebook Name is Kim Xavier - Stenovator
Do you currently use Scentsy products?
YES
NO
What type of scents do you enjoy and prefer?
Clean/Fresh
Fruity
Citrus
Bakery
Floral
Spice
Woods
I don't have strong preferences
List any products you have not tried or would like to try or that you would like to see in the Live Demo (Scent Social Attendees only).
Do you use essential oils?
YES
NO
Do you have young children in your life under age 10? (Your children, grandchildren, nieces, nephews, god children, etc.)
YES
NO
Do you have pets?
Cat
Dog
Other
No pets
Do you have a couple of friends who may need bulbs, wax bars, or other scented goodies?
YES
NO
MAYBE (tell me why you're asking)
On a scale of 1 to 5, how interested are you in earning free and half-priced scented goodies for yourself?
1
2
3
4
5
Worst
Best
1 is Worst, 5 is Best
Would you like to be spoiled with free and half-price scented goodies for yourself?
OF COURSE
NO, I am fine paying full price
MAYBE (tell me more)
On a scale of 1 to 5, how interested are you in earning extra money on a monthly basis?
1
2
3
4
5
Worst
Best
1 is Worst, 5 is Best
On a scale of 1 to 5, how interested are you in earning free vacations for yourself and family members?
1
2
3
4
5
Worst
Best
1 is Worst, 5 is Best
Do you know anyone else who would be interested in earning extra money, starting a new business, and/or taking all-expense paid vacations? (Any referrals are appreciated and rewarded. Our team is growing and we welcome everyone.)
YES
NO
BEFORE YOU CLICK SUBMIT, PLEASE DOUBLE CHECK YOUR EMAIL AND MAILING ADDRESS.
Due to the rising costs of postage, packages returned for incorrect addresses will not be resent.
Submit
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