Sample Request Form

Lauraville provides customers samples of our Smart-Pack (preloaded custom packing list envelopes on continuous liner) and Versa-Label ("encapsulated" booklet labels) branded products at no charge.

Please provide the information requested below and we will be happy to process your request. All samples are shipped via first class mail.

	Yes, I would like a sales representative contact us!
*Name
*Company
Department
*Title
*Address 1
Address 2
*City
*State/Province
*Zip/Postal Code
*Phone
Fax
*Email
	Please send a Smart-Pack sample
	Please send a Versa-Label sample
Project Reference Name:
*Annual Quantity
	*Please describe your application. Please include the size of the insert as it is ready to be packaged (width, length and thickness).
	What problems are you currently having (check as many as apply):
	Takes too long to hand load
	Takes too long to hand apply
	Too many repetitive motions
	Housekeeping
	Other (please explain):
	How did you hear about us?
	Google
	Yahoo
	MSN
	AOL
	Ask Jeeves
Other
	Distributor
	Referral
	How soon would you expect to make a purchase assuming our samples worked out as you expected:
	within 60 days
	60-90 days
	longer than 90 days
	Please have a distributor contact me