David's Cookies - Lipari

Sample Request Form *Must Fill Out EntireFromOrWeWill Not ProcessRequest!

Who?

RequestedDate:

PickUpDate:

ShipDate:

Sales Rep/ Broker Name:

PickUp Time:

DeliveryDate:

2ndDay Shipper Overnight

Phone:

Email:

Where?

Purpose of the Sample Request

Contact Name:

NewCustomer

NewDistributor

Current Customer/Distributor Presentation

What? Phone #: Address: Company: City: State:

UPS TrackingNotification (Email Addresses)

Zip:

**Must Request At Least 10BusinessDays From ShipDate**

Kit # / Item #

Product Description

Size/Wt.

QTY/Pack

Return to YakovBreuer - Yakov@davidscookies.com

PreparedBy: ________________________________ Date: _________