Sample Request Form

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Sample Request Form

Please use this form to help me figure out what the best samples are to send you! :)

Email *

Name
*

Name on Facebook (If different from above, so that I can contact you if needed!)

Street Address

City, State and Zip Code
*

What kind of scents do you like? (Please select all that apply)
*

Sweet - vanilla cake, coconut, sugared violets, etc.

Fruity - orange, raspberry, strawberry, bergamot, etc.

Gender neutral - woodsy, amber, sandalwood, etc.

Natural - honey, cucumber, etc.

Floral - orchid, citrus blossoms, etc.

Lavender (I'm putting this seperate for sensitivity reasons)

Fragrance free

Required

What kind of products are you interested in trying? (Please choose more than one!)
*

Chunk Bar or Snarky Bar

Hand Creme

Facial Cleanser & Moisturizer

Body Creme or Body Butter

Body Scrub

Face Mask

Another item not on this list

Required

What type of skin do you have?
*

Are you looking to solve some type of issue with your skin? (Please select all that apply!)
*

*Please note: We are not doctors but we will do our best to try and find something that might help!*

Help with oily skin

Help with dryness

Help with a skin condition such as rosacea

Lessen or get rid of rinkles

Tighten skin

None of the above

Required

Please add anything additional information I might need to know here. This could include any of the following: allergies, if you want to give me any additional information to any of these answers, or if you are looking to try a certain product.
*

Thank you so much for your interest in Perfectly Posh! I will contact you and/or send your samples out very soon!

Rainbows&Posh

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