SAMPLE REQUEST FORM

To be completed by a CLEAR FOCUS distributor.

To request samples, please complete the request form below.
A CLEAR FOCUS representative may contact you for more information.

Don’t have a CLEAR FOCUS distributor? Call 707-544-7990 or email us with your name, company name, and city/state/country for a referral.

• All samples are shipped on distributor’s account via ground unless requested otherwise under Special Instructions.
• Product details and codes can be found on the individual product pages under Products.
• Have questions or need assistance? Contact your CLEAR FOCUS Regional Sales Manager.

 

		DISTRIBUTOR INFORMATION
Date:
Distributor Name:	*
Contact:	*
Street Address:	*
City:	*
State:	*
Postal Code:	*
Direct Phone:	*	( ) - ext.
Mobile Phone:	*	( ) -
E-mail:	*
Preferred contact method for follow-up:	*	Email     Phone
		END USER
Company Name:	*
Contact:	*
Street Address:	*
City:	*
State:	*
Postal Code:	*
Direct Phone:	*
Cell Phone:	*
E-mail:	*
Experience with CLEAR FOCUS film:	*	Existing user     New user
		PRINTER INFORMATION
Printer Make:	*
Printer Model:	*
Printer Type:	*	(Check all that apply)
		UV-cure
		Latex
		Solvent, eco-solvent
		Screen printing
		Thermal transfer
		Aqueous inkjet
		Other (describe below)
		SAMPLE REQUEST
Requested Product Sample(s):	*
Ship sample(s) to:	*	Distributor   End user
		DISTRIBUTOR SHIPPING ACCOUNT INFORMATION
Shipping Method:	*	UPS     FedEx     Other
Shipping Account #:	*
Special Instructions: