A $10.00 PER CASE SERVICE CHARGE WILL BE
APPLIED TO ANY EMERGENCY SAMPLES!
* Sample requests must be emailed or faxed to ‘Samples’ at firstname.lastname@example.org /
631-758-6096, at least 24 hours in advance, there will be no exceptions.
** Upcharge for sample requests will be $7.50 per case. You must specify deduction or billing.
If you do not the charge will be automatically deducted from the invoice.
*** Please fill the form out in its entirety, a separate form should be filled out for each invoice
If sending a check or credit memo please send directly to Sunil Chadha, Purchasing Dept., and
specify “For Samples”, the invoice number must be on all correspondence.