Sample Request Distributors Form

Sample Request Form - Distributors

The Sample Request portal will allow distributor representatives to request sample products. With approval, samples will either ship from Comtrend, or from the distributor with full credit.

Are you a Service Provider?

1) Distributor Rep Information.

Distributor Rep Name

Distributor Rep Phone

Distributor Rep Email

2) Distributor Name

Distributor Name

3) Company receiving sample(s)

Company receiving sample(s)

4)Shipping Information

Recipient's Name

Shipping Address

Recipient's Phone Number

Recipient's Email Address

5) Samples Request - (3 Maximum, otherwise Request Exception)

Request Sample(s) Model I

Notes:

Request Sample(s) Model II

Notes:

Request Sample(s) Model III

Notes:

Additional information (if desired)

6) Reason for Sample Request (background)

Reason for Sample Request (background)

7) Competitive & Additional Information

Please add any competitive information (model, price, source), or anything additional you want us to take into consideration.

8) Sample Source (Required)

Distributor stock means you will send and Comtrend will credit the value of product. Comtrend stock means we will send.

9) Did you confirm that the customer will test and evaluate within two weeks of receipt?

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Sample Request Form - Distributors

Are you a Service Provider?

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