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? Click Here for Sample Request Form 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. Comtrend (5-10 days via ground) Distributor Inventory (Depends on distributor) 9) Did you confirm that the customer will test and evaluate within two weeks of receipt? Yes No Send