Product sample request form
A sample request form lets potential wholesale or bulk customers test your product before committing to a large order. Rather than a full purchase, they submit their company details and which product they want to try. You then ship the sample and they get first-hand experience before deciding to order cases or pallets. This reduces buyer hesitation and accelerates deals.
The form beside this text is live. Fill it in and submit it — it validates exactly as it would for a real respondent, and saves nothing.
Company name and shipping address are separate from requester contact
The person filling out the form may not be the person receiving the sample. Splitting requester contact from the shipping destination ensures the sample reaches the right place.
Product interest is text, not a strict dropdown
If you offer many products or variants, a textarea lets customers describe exactly what they want to test — including size, colour, or format — rather than forcing them to pick from a limited list.
No card required.
Product Sample Request
Live previewHow to build this form
5 steps in the editor. Nothing here needs a paid plan.
- Add text fields for the requester's name and email address so you know who to contact about the sample.
- Add a text field for company name and a textarea for shipping address.
- Add a field for "product(s) of interest" — use a textarea if you have many products, or a dropdown if you want to limit it to a few bestsellers.
- Add an optional textarea for "intended use case" so you understand how they plan to use the product.
- Optional: add a text field for quantity they intend to order if the sample goes well, so you can forecast and prioritise high-potential leads.
Fields in this form
7 fields, using 3 of the 19 field types available.
| Question | Field type | Required |
|---|---|---|
| Your full name | Short text | Yes |
| Email address | Yes | |
| Company name | Short text | Yes |
| Shipping address | Long text | Yes |
| Product(s) of interest | Long text | Yes |
| Intended use case (optional) | Long text | Optional |
| Estimated order size if sample is approved (optional) | Short text | Optional |
What goes wrong with this form
Specific to a product sample request form, not general advice about forms.
Collecting credit card or payment info on a sample form
Samples are free by design — collecting payment turns it into a mini-store and defeats the purpose. Keep the form free and handle payment later when they commit to a bulk order.
Asking for a password or account login to submit
This form should work without registration. Keep the bar low so casual prospects can request a sample in under a minute.
Forgetting to ask for shipping address, or making the field too short
Shipping addresses are often two or three lines. A textarea with no length limit beats a cramped text field that forces the customer to abbreviate.
Questions about this form
Should I limit sample quantities?
Yes. You control the sample size — send enough to test fairly, but not so much that the sample cost wipes out your margin.
How long should I wait before following up?
Follow up in 1–2 weeks to ask if they received the sample and what they think. A light touch keeps the door open without being pushy.
What if someone requests samples repeatedly without buying?
After a few requests with no purchase, politely ask if they intend to place an order. Some requests are fishing for free products; filtering those out saves fulfilment cost.