Beautycounter Sample Request Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Interested in trying some Beautycounter? Fill out the form below and I will send you some!

You may also want to take the skin care quiz to help you determine what may be best for your skin. Follow the link below and at the end when it gives you the option to send results to consultant just type in Christina Fulmer and it will send me a copy as well.

https://www.beautycounter.com/christinafulmer?goto=/quiz/skincare

Name (first & last) *

Mailing Address (full address including zip code) *

Email Address *

Have you tried Beautycounter before? *

Yes, love it!

Not yet!

Are you currently working with an active consultant? *

Yes

Please choose up to two samples you would like to try: *

Counter+ Charcoal Cleansing Bar

Countercontrol (designed to treat oily and blemish-prone skin—without irritation)

Countermatch (for intense hydration, great for most skin types including sensitive and/or dry skin)

Countertime (anti-aging and hydration that works for all skin types)

Counterman (safer results driven skincare for men)

Counter+ Charcoal Face Mask

Tint Skin (lightweight creamy foundation)

Countersun Mineral Sunscreen Lotion

Counter+ Overnight Resurfacing Peel

Counter+ All Bright C Serum *New

Other:

Required

Do you have any of the following concerns *

Acne

Dryness

Dullness

Overproduction of oil

Fine lines/wrinkles

Aging Skin

Skin Spots or Discoloration

Sensitivity

Other:

Do you have any question about Beautycounter or safer personal products in general?

What's your Instagram handle, let's connect

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms