TODAY'S DATE |
|
SALES REPRESENTATIVE |
|
|
BUSINESS NAME |
|
PHONE |
|
CONTACT NAME |
|
EMAIL |
|
TITLE |
|
WEBSITE |
|
|
BILLING ADDRESS STREET |
|
CITY |
|
STATE/PROVINCE/COUNTRY |
|
ZIP |
|
SHIPPING ADDRESS STREET |
Same as Billing Address |
CITY |
|
STATE/PROVINCE/COUNTRY |
|
ZIP |
|
|
REASON FOR SAMPLE REQUEST |
New Customer Enquiry
Existing Account Adding Fragrance Or Line
Customer Service Issue ** |
Customer Promotional Event **
Press Sample Request **
Other ** |
IF YOU SELECTED A CHECK
BOX WITH ** PLEASE
PROVIDE FURTHER INFORMATION |
|
(Requests Related to Promotional/Press Events Are Automatically Forwarded to Marketing) |
|
PLEASE SPECIFY TYPE OF
SAMPLE REQUESTED |
Body Samples
Facial Samples
Gift Samples
Cold Call Sample Kit |
|
PLEASE SPECIFY YOUR
MAIN PRODUCT FOCUS |
Retail Only
Treatment Only
Both Retail & Treatment |
|
PLEASE SPECIFY
FRAGRANCES REQUESTED |
Coconut
Coconut Lime Blossom
Coconut Milk & Honey
Dilo
Frangipani
Guava
Herbal Detox
Island Bliss
Mango
Orange Blossom
Passionflower
Pineapple
Starfruit
White Gingerlily
|
|
|
PLEASE SPECIFY CUSTOMER'S
PREFERRED PRODUCT SIZE AND
AMOUNT REQUIREMENTS |
|
|
OTHER SPECIAL CUSTOMER
REQUIREMENTS |
|
|
|
|
