Mixly Cocktails Sample Request Form

1
Choose Your Free Samples* This field is required.Choose up to 3 free samples of our patented stabilized active oxygen creams—simply click to select, and your choice will be highlighted. Enjoy 50% OFF RRP for wholesale!
2
Business Type* This field is required.
Please Select
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Appliance Store
Art Gallery and Exhibition Spaces
Art Supply Store
Athletic and Sportswear Store
Automotive Parts and Accessories Store
Baby and Kids Fashion Store
Baby and Kids Store
Bakery
Bait and Tackle Shop
Bar/Pub
Barber Shop
Beauty and Cosmetics Store
Bicycle Shop
Bike Rental Shops
Book Store
Boutique
Butcher
Camera and Photography Store
Car Dealership
Car Rental Offices
Car Wash and Detailing Services
Casual Dining Restaurant
Clothing Alterations and Tailor Shop
Coffee Shop
Comic Book Store
Construction and Contractor Supply Store
Convenience Store
Corporate Offices
Coworking Spaces and Business Centers
Craft and Hobby Store
Craft Brewery/Distillery
Craft Workshop Spaces (DIY-focused stores)
Dance and Performing Arts Studio
Daycare and Learning Centers
Department Store
Dollar Store
Dry Cleaners and Laundromats
Educational Supply Store
Electronics and Gadgets Store
Event Planning and Management Offices
Farm Equipment and Supplies Retailers
Farmers Market
Financial Services Offices
Fishing and Hunting Supply Store
Florist
Formal Wear and Bridal Shop
Furniture Store
Garden Center/Nursery
Gift Shop
Grocery Store
Gym and Fitness Center
Hair Salon
Hardware Store
Health and Wellness Store
Hearing Aid Center
Home Decor Store
Home Improvement Store
Hot Tub and Sauna Retailers
Industrial and Safety Supply Store
Jewelry Store
Kitchen Supply Store
Law Offices
Liquor Store
Luggage and Travel Accessories Store
Mattress Store
Medical Equipment and Supply Store
Medical Spa (Medi-spa)
Men's Fashion Store
Mobile Phone Store
Music Store (Instruments and Accessories)
Nail Salon
Office Supply Store
Optical Store
Outdoor Gear Store
Party and Event Rentals
Party Entertainment Services (e.g., DJs, Event Hosts)
Party Supply Store
Pet Grooming Services
Pet Store
Pharmacy
Photography Studio and Print Shop
Pool and Spa Supply Store
Pop-up Store
Printing and Signage Shops
Real Estate Agencies and Offices
Record/Vinyl Store
Religious Goods Store
RV and Camping Supply Store
School Uniform Store
Secondhand Electronics Store
Self-Storage Facility Offices
Shoe Store
Seasonal Pop-Up Stores (e.g., Halloween, Christmas)
Specialty Food Service
Spas and Wellness Centers
Sporting Goods Store
Stationery and Card Store
Surf and Skate Shop
Tattoo and Piercing Shop
Tech Repair Shop (Phones, Computers)
Textile and Fabric Store
Thrift/Consignment Store
Tobacco and Vape Store
Toy Store
Travel Agency and Tour Operator Offices
Vintage Clothing Store
Video Game Store
Wedding Planning and Event Coordination Services
Wine Shop
Women's Fashion Store
3
Business Name* This field is required.
4
Website* This field is required.
5
Full Name* This field is required.
First Name
Last Name
6
Role / Position within Business* This field is required.
Owner / Founder
Manager / Store Manager
General Manager / Director
Buyer
Other
7
E-mail* This field is required.
example@example.com
8
Contact Number* This field is required.
9
Delivery Address* This field is required.Where should we ship your samples?
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
United States
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Iraq
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Israel
Italy
Jamaica
Japan
Jersey
Jordan
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Kenya
Kiribati
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Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
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Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
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Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
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Palau
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Panama
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Peru
Philippines
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Poland
Portugal
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Republic of the Congo
Romania
Russia
Rwanda
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Saint Helena
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10
Are you registered on any of the following?* This field is required.
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