APR Logo - Click here to return to home page

Advanced Package Rework

Sample Request Form

Thank you for your interest in MENDA products. No-charge samples of our products are available for testing/review purposes for qualified applications. To determine if your application qualifies, please complete and submit the form below.

Please enter the following information for each item(s) you are interested in:

* Part No. and/or Description:
Sample Quantity:
Potential Order Quantity:
When will you be ordering this item?

Additional Information and/or Sample Reason:

Please enter the shipping address you would like sample(s) sent:

*E-mail Address:
Address 2:
*Zip/Postal Code:
*Phone Number:
*Are you a Distributor?

* Will these items be resold?

*Required fields.

All samples are processed at Desco Industries, Inc. (DII) discretion.