Requesting A Sample - submission form

"Your team was excellent! They were very helpful and I received everything on time. I will be pleased to recommend you to others in the future!"

Whitney Ashe, Associate Director, Harvard Law School Fund

If you've narrowed your selection to one or two products and would like to see a sample before making your final decision, we'd be happy to send you one.

*Use the "tab" key to move from blank to blank. If you hit the "enter" key, it will submit the form at that stage and you'll need to hit "back" on your browser to complete and resubmit the form.

REQUEST FORM

Request number (please enter date)

(## ## ##) month date year - two digits with no / or - in between

For what purpose are you planning?

Is there a specific in hands date?

(enter "no specific date" if this is for an ongoing program or you are doing advance research for an event several months away)

How did you find out about us?

(please list name ( ) of specific conference, person referring, website, etc)

repeat customer	( ) referred me	( ) salesperson
postcard mailing	( ) conference	( ) listserv
other - how?	( ) internet search	( ) newsletter
	( ) website	( ) magazine

First Item #

Description

Desired Item Color

(we always try to send a sample in your desired color if one is available. If not, another color will be substituted)

Desired Imprint Color

(we always try to send a sample with your desired imprint color if one is available. If not, another color will be substituted)

Item Size (if applicable)

What quantity might you need to order?

Second Item #

Description

Desired Item Color

Desired Imprint Color

Item Size (if applicable)

What quantity might you need to order?

SHIP TO ADDRESS:

Name

Title/Office

Organization/School

Street Address
(CANNOT SHIP TO A PO BOX!)

Address 2

City

State

Zip

Phone # and ext. #

Fax #

E-mail

Charge Shipping to Fedex or UPS#

or credit card
(required for samples valued over $10. For items valued at over $25, we also charge for the sample. This may be returned to us for credit, however, or deducted if you place an order)

Additional Comments

Thank you for your request.
We hope we can help make your program or event a success!

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