Product Sample Request Form Template

Template Instructions

SurveyPluto's product sample request form template streamlines the process of managing requests for product samples from potential customers. This intuitive template allows users to specify their interests and provide essential contact information, ensuring your team can efficiently distribute samples and follow up effectively. It's an ideal solution for businesses aiming to boost product visibility and customer engagement by offering a taste of what they have to offer. Enhance sales by utilizing this template now.

11
Questions
Use This Template

Product Sample Request Form Template

Hello! Take the first step towards enhanced wellness. Complete this form to discover products tailored specifically to your health objectives.

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*
1.
Let's start with some basic information about you!
Name
Name
Email
Email
Phone number
Phone number
*
2.
What is your age group?
Under 18
18-24
25-34
35-44
45-54
55 and above
*
3.
What is your gender?
Male
Female
Prefer not to say
Other (Please specify)
*
4.
Which category of health supplements are you interested in?
Vitamins & Minerals
Protein Powders
Herbal Supplements
Omega-3 Fatty Acids
Probiotics
Other (Please specify)
*
5.
What is your primary goal for using health supplements?
General wellness
Immune system support
Muscle building
Weight loss
Energy boost
Other (Please specify)
*
6.
Have you used health supplements before?
Yes (Please specify the brands)
No
*
7.
Do you have any dietary restrictions or allergies we should be aware of when sending your sample?
No
Yes (Please specify)
*
8.
Please provide your shipping address for the sample.
Address
Address
City and State
City and State
Zip Code
Zip Code
Country
Country
*
9.
Would you be interested in participating in a brief survey about your experience with the sample?
Yes, I'd be happy to provide feedback.
No, I'm not interested.
*
10.
How did you hear about our health supplements?
Social media
Recommendation from a friend or family member
Online advertisement
Health blog or magazine
Other (Please specify)
*
11.
Would you like to receive information about new products and promotions from us?
Yes
No
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