Name: Email:

Company: Phone #:

Your Website:

Address:City:
State:Zip:

You must have a UPS account. To obtain a UPS Account go to UPS.COM. Takes like 5 minutes.
UPS Account #:

Type your sample request in the box below. Please be specific using our part number. We will not except a random request. No Charge for the sample. Customer pays the shipping. Limit the request to 1 or 2 items. Make sure your UPS Account is valid or the request will be rejected ..
You can type as much as you need in the box below:
Sample Request :

If your request is of a personel nature, it will not be filled. This is for business requests only. If the form is not completely filled in the request will be rejected.