SidePinch Clamp Sample Request Form

Check boxes below* to indicate the SPC sizes of interest to you. Each sample pack includes 3 SPCs plus an information package:

		Micro-SPC in White (Product Code SPC-001)
		Mini-SPC in White (Product Code SPC-101)
		Medium-SPC in White (Product Code SPC-201)
		SPC information package

* Required

* Your Name:

* Your Title:

* Company Name:

* Mailing Address:

* City:

* State/Province:

* Zip/Postal Code:

* Country:
Other Country:

* Phone Number:
Extension:

* E-mail Address:

Terms & Conditions:

Suitability for use of any product must be determined by the customer.

Beginning January 1, 2010 -- All SPC sample shipments will be subject to shipping and handling fees of US$7.95 for U.S. shipments. Outside of U.S. shipments are subject to higher shipping fees quoted at time of order prior to shipment. Fees are payable by credit card only in advance of shipment and are subject to change without prior notice.

Express delivery is available billable to your express delivery service account. If desired, please complete the following information:

Carrier: (FedEx, Airborne, DHL, UPS, or USPS)

Account #:
Priority: (Next Morning, Next Day, 2-Day, 3-5 Days)

* Captcha

FDA cleared, Canadian approved & CE Marked - U.S. Patent No.6,234,448.

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