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Manufacturer Sample Notification Form
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Rev – 1.1
Sample Request Form
4615 State Street, Montclair, CA 91763 | t: (909) 627-5333 | f: (909) 627-2887 | e: [email protected]
REQUEST FOR SAMPLES
Archipelago Lighting is proud to manufacture premier LED lighting products. It is important for our distributors and sales reps to obtain samples for the customer base they service to interact with and to secure specification opportunities.
In order to provide an efficient and accurate inventory of our samples, we require all sample requests to adhere to our sample policy.
* Distributor / Rep Agency Name * Contact Name * Email Contact Number * Product Number and Quantities * Shipper Account Number * Delivery Address Address line
City State Postal * Please describe the opportunity, including the application(s), quantities, and other pertinent information
* Billing Information (No Cost is determined by Sales Manager)
If Credit Upon Return, Specify Desired Return Due Date
If Purchase or Credit, Billing Address Address line City State Postal
Our Sample Policy allows product samples to be easily purchased and returned for full credit, when returned in new condition and in the original packaging:
No Cost – Returning Samples Cost – Purchasing Samples Credit Upon Return • Invoiced samples to be returned within 60
days • Contact Customer Service for RA# (909-627-
5333) • Must be returned in New Condition and in
the • Original Packaging • Returns must be freight prepaid
Rep Agency – • Sample Kit will be provided on a loaner
basis • All Sample Kit must be returned freight
prepaid in the event of resignation or termination
Customers – • Samples paid in advance or NET60 – per
Sales • Department discretion • Freight charged against Customer’s freight
account
• Full credit will be issued for samples returned in New Condition and in the Original Packaging
• Please note that any return freight damage is the responsibility of your customer and their carrier
By signing here, I agree to ARCHIPELAGO LIGHTING’s Sample Policy: Signature: _____________________________ Date: ______________________________
4615 State Street, Montclair, CA 91763 | t: (909) 627-5333 | f: (909) 627-2887 | e: [email protected]
No Cost Purchase Credit Upon Return
