Sample Order Form

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First Name*

Last Name*

Business Email Address*

Company*

Country

Supplier Type:

Customer Type:

Brand Name Samples will be submitted for:*

Select RFID Item Code (use pictures above as reference)*

Item Description*

Barcode (please select one)*

Enter your Barcode No. for your Brand (based on previous answer):*

(Only 5 samples are required for Auburn Lab Approval)

Sample Quantity*

Please enter your shipping information below in English:

Shipping Contact Name:

Contact Phone Number*

Address Line 1*

Address Line 2

City*

State / Province

Shipping Country/Region*

Postal Code*

How would you like your these items shipped?*

If Other, please specify:

What is your account number for your carrier?*

Would you like your samples expedited? *

Yes

(Standard lead time: 5-7 working days; Expedited: 5 working days)