Sample Request

This form should not be completed by medical facilities looking for samples for clients, the correct form would be the Medical Partners Program form.

Form for Non-Profit, For-Profit, or Industry Reviewer

The following are not eligible for in-kind product donations:

Individuals, family/friend reunions, bachelor/bachelorette parties, birthday parties, religious events, political events, and more.

Lead Time

Groups must apply at least two (2) months prior to the date the products are needed. This is to ensure ample lead time for our representatives to verify, confirm, process, and ship the donation.

ORGANIZATION OR INDIVIDUAL NAME*
EMAIL*
Enter Email Confirm Email
ARE YOU A NONPROFIT?*
NONPROFIT CATEGORY*
NONPROFIT CLASSIFICATION*
EIN NUMBER*
ARE YOU A REVIEWER*
PROMOTIONAL EVENT*
Agree to the Product Donation Guidelines*
- Yes, I have read the Product Donation Guidelines
Reason for samples?*
Tell us about your event / promotion*
Social Media Handles*
Event Date*
MM slash DD slash YYYY
Event Address*
BRANDS YOU ARE INTERESTED IN*
- Select All
- Sliquid Naturals
- Sliquid Organics
- The Balance Collection
- Ride BodyWorx
Quantity of Samples Requested*
WEBSITE OR PUBLICATION*
MAILING COUNTRY*
MAILING STREET*
MAILING CITY*
MAILING STATE/PROVINCE*
MAILING ZIP/POSTAL CODE*
Event Organizer Contact Details
Name*
First Last
PHONE*
EMAIL*
Enter Email Confirm Email
Venue Name*
Is this a virtual event ?*
Venue Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Venue Phone Number*
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