TECHSPAN SALES REP SAMPLE ORDER FORM Sales Rep : Sample Request Date : Sample Details Product # Quantity : Company Name : Contact Name : Ship to Address: End User Name: Reason For Sample : No Charge Sample: Chargeable Sample : If chargeable, provide return date: Shipping Method Ship PDD: Ship Collect: Courier: Account #: Order Details - To be completed by the customer representative responsible Entered By: Order #: Ship Date: Additional Notes Submit
