Trials and Evaluations

Trial and Evaluation Form

Name (First and Last)

Company Name

Job Title

Phone Number

Shipping Address

PART #/PRODUCT NAME FOR SAMPLE REQUEST

Preferred distributor partner(s) for quoting

How many units would you be potentially purchasing?

Timeline for making a purchase (30 Days, 60 Days, 90 Days, Other)

Are you currently using a competitive product? (Yes/No) If Yes, what is the product?

Required date to receive samples

Reason for evaluation

Would you like an onsite visit for a demo of this product or others?

Commitment Date for follow Up