Today's Date
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Month
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Day
Year
Date
Associate Info:
Waterworks Associate Name
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First Name
Last Name
Associate Email Address
*
ex: you@waterworks.com
Associate JDE Salesperson #:
*
ex: 2341
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Client Info:
Sold To Account #:
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Ship To Account #:
*
Project Name:
*
Requested Date
*
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Month
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Day
Year
Service level:
*
Please Select
S01 - Standard
S02 - 2-Day
S03 - Overnight
BU #
*
Are we charging client for this sample?
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No
Yes
Please attach completed Credit Card Authorization Form here:
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Product Info:
Please provide information for samples needed here:
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Additional Info:
If we should have any questions, can a Client Support Specialist reach out to your client directly?
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