Sample Request

	Dell Account Rep Information:
	Email *
	First Name *
	Last Name *
	Phone *

	Customer Name:
	What Industry?

	Ship to Information:
	Who are we shipping samples to?	Dell Account Rep Direct to Customer
	Ship to First & Last Name:
	Ship to Address:
	City:
	State/Province:
	Country:
	Zip code:
	Ship to Phone:
	Choose from the following list of samples:
	Product not in the list above? Please put the product name and number into the space to the right:
	Describe the sales opportunity (example: evaluation lab responsible for 2,000 seats) *
	Sample quantity (max 2 per order)
	If this is a competitive bid, what manufacturer are we competing with?

	All orders must be verified by a Kensington representative. Kensington reserves the right to refuse any request in its sole discretion.


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