Clean Eau de Parfum Sample Request Form

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This short form will only take a minute and in return I'll send you samples via snail mail. There is no purchase requirement to request samples from me, but they do cost me money to both purchase and ship. In return, I ask that if you do decide to purchase, you will select me, Stacy Toth, as your Brand Advocate at checkout. I'll make it worth your while with a coupon included in your package! ✨ xo Stacy

Email *

I can't wait to help you find your new signature scent from Beautycounter's Clean Eau de Parfum! The first "fragrance-free" perfume, tested against 23 human health endpoints, clinically proven sensitive safe, vegan and cruelty-free, sustainably sourced and packaged, and EWG-verified. Perfumes make the mood, but ours is making history!

Confirm you're not a bot, enter the answer to 1+4 below. Hint, it's the number of scent options for Beautycounter's perfume!
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First & Last Name *

Full address (Street, City, State, Zip) to send samples to! *

How did you find this form? *

Stacy's newsletter

Stacy's website (RealEverything.com)

Instagram (@realstacytoth)

Other:

Now, let's find your signature scent! You can learn more about each scent in my guide HERE

Still not sure? Try THIS QUIZ (optional)

Please choose 2 scents you'd like to try! *

MILES AWAY: Like a calming walk in the woods! Drop into the deep wild with this woody and restorative scent. Top notes: Lemon, Bergamot; Heart: Chamomile, Jasmine, Juniper Berry; Base notes: Cedarwood, Sandalwood, Vetiver (gender neutral)

SUN SPILL: Summer’s golden glow as a scent. Try this sun-drenched floral and citrus scent is bright and uplifting! Top notes: Grapefruit, Neroli; Heart: Rose Petals, Jasmine, Coriander; Base notes: Vetiver, Cedarwood (gender neutral)

HYPER ROSE: Enjoy this sultry soft floral with a lavish twist! It’s redefined to a true garden rose with gardenia for an effortless softness rooted with a woody depth. Top notes: Bergamot, Cassis; Heart: Turkish Rose, Gardenia, Apple Blossom; Base notes: Cedarwood, Cashmere Woods (feminine scent)

SECOND SKIN: Like a warm, elegant sensual experience! Get all wrapped up in quiet luxury with this vanilla and floral-amber scent. Top Notes: Bergamot, Grapefruit, Blood Orange, Lemon; Heart: Jasmine, Rose, Cinnamon, Lily of the Valley; Base Notes: Vanilla Creme, Sandalwood, Musk, Amber (feminine scent)

PACIFIC DREAMS: Visit immaculate, fresh beaches with sparkling, sunlit waves in an invigorating, clean aquatic scent! Top notes: Sparkling Lemon, Bergamot, Lavender; Heart: Orange Flower, Jasmine, Marine Accord; Base notes: Cedarwood, Vetiver, Crisp Musk (gender neutral)

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What best describes you? *

I have not yet shopped Beautycounter products.

I currently shop Beautycounter with you (Stacy Toth)!

I shop Beautycounter with another consultant (but want to shop with you next).

Would you like any other samples included? (optional)

Countertime (RetiNatural Anti-Aging Skincare)

Countermatch (Hydration for Normal and Sensitive skin)

Countercontrol (For Oily Skin & Teens)

All Bright Vitamin C Serum

Reflect Effect AHA Smoothing Mask

Balancing Charcoal Facial Mask

Other:

Any comments or questions? (optional)

Your Phone Number (optional, if you'd like to receive occasional texts about special offers and deals!)

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