Sample Request Form

Thank you for your interest in MENDA products. No-charge samples of our products are available for testing/review purposes for qualified applications. To determine if your application qualifies, please complete and submit the form below.


*Please enter the following information for each item(s) you are interested in:
Part No. and/or Description [ ]   Sample Quantity [ ]   Potential Order Quantity [ ]   When will you be ordering this item? [ ]

Additional Information and/or Sample Reason:

Please enter the shipping address you would like sample(s) sent:


*Name:
*Title:
Company:
*E-mail Address:
*Address:
Address 2:
*City:
*State/Province:
*Zip/Postal Code:
*Country
*Phone Number:
*Are you a Distributor?

* Will these items be resold?


*Required fields.

All samples are processed at Desco Industries, Inc. (DII) discretion.


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