Sample Request Form

Binder-USA has a sample policy for its OEM customers. We will provide you with a max of two samples for up to three part numbers for ongoing design-in projects. Non-OEM customers please order your parts through our sales department. We appreciate your under standing.

If you are a OEM customer and would like to receive samples in accordance with our sample policy, please complete the entire form.

Company Information
 
Company Name
 
First Name 		  
Last Name 		 Title  
 
 
Address 
 
City 		  
State 		  
Postal Code 
 
Country
 
Telephone		  
EMail
 
Our sample policy is to provide a max. of two samples for up to three part numbers. Please provide us with your shipping account number (UPS, FedEx, etc.)
  Shipper Account Number
 
 
Sample Requests
Please fill in the requested part numbers and the est. annual quantity.
Part Qty Est. annual usage
Project Information
 
Brief description of your application:
 
When do you expect to go into production:?
2-6 months 6-12 months don't know yet
Click SUBMIT REQUEST to email this request to Binder-USA.
If you like to contact us by telephone, please call 805.437.9925