Beautycounter Sample Request

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Please complete this form so I can customize your sample needs.

*If you have not taken the skincare quiz yet, start here:
https://www.beautycounter.com/brennamay?goto=/quiz/skincare

Name ( First + Last) *

Email Address *

Street Address (where you would like the samples sent): *

City *

State/Province *

Zip/Post Code *

Country (if outside the USA)

What are you most interested in?

Skincare

Makeup

Counterman

Body

Shampoo & Conditioner

Other:

Which regimen did the skincare quiz recommend for you?

Countermatch (normal/combination skin, occasional breakouts, redness, dryness, or oil in T-zone)

Countercontrol (consistently oily skin with fairly regular breakouts)

Countertime (combination/dry skin, fine lines, uneven texture, pigmentation, or hormonal breakouts)

Counterman (an oil-free line dedicated to men's skincare and shaving needs)

Clear selection

Which other best sellers are you interested in? *

Overnight Resurfacing Peel

All Bright C Serum

Balancing Charcoal Mask

AHA Reflect Effect Mask

Lotus Glow Cleansing Balm (currently out of samples)

Countersun SPF 30 Lotion

Skin Twin Featherweight Foundation (Fair 110 - Med 350)

Skin Twin Featherweight Foundation (Tan 410 - Tan 460)

Skin Twin Featherweight Foundation (Dark 510 - Deep 650)

Skin Twin Creamy Concealer - Fair to Light

Skin Twin Creamy Concealer - Med to Tan

Skin Twin Creamy Concealer - Dark to Deep

Other:

Required

What is your Instagram handle?

What best describes you? *

I have never shopped Beautycounter

I shop Beautycounter with Brenna May

I shop Beautycounter with another consultant

Are you interested in attending a ZOOM, in person Pop-Up or having a one on one consultation to learn about switching to safer?

ZOOM Pop-Up

Live Pop-up

One on One Consultation

Other:

Clear selection

Are you interested in hosting a live or referral based pop-up and earning rewards?

Yes

Maybe, tell me more!

Clear selection

Are you interested in the Consultant opportunity? *

Yes

Maybe

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