MENDA - 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:

Website:

*Are you a Distributor?

Yes
No

* Will these items be resold?

Yes
No

*Required fields.

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

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