Sample Request Form Account Manager * First & Last Name Requested Ship Date Please note that sample production times may vary and will be confirmed upon request. If we’re unable to meet your requested ship date, Maggie will reach out to you. MM DD YYYY Deliver by Date MM DD YYYY Customer Information * Business Name Contact's Name Contact's Email Contact's Phone Number (###) ### #### Shipping Address Address 1 Address 2 City State/Province Zip/Postal Code Country Other Shipping Instructions? ATTN, Pickup etc. Sample #1: * Roast (Light / Dark) No Preference 75 / 25 (Light / Dark) 50 / 50 (Light / Dark) 25 / 75 (Light / Dark) 100 (Dark) 100 (Light) Custom Strength Ready to Drink 4X (Espresso Strength) 10X Custom Quantity Custom Instructions Sample #2: Roast (Light / Dark) No Preference 75 / 25 (Light / Dark) 50 / 50 (Light / Dark) 25 / 75 (Light / Dark) 100 (Dark) 100 (Light) Custom Strength Ready to Drink 4X (Espresso Strength) 10X Custom Quantity Custom Instructions Sample #3: Roast (Light / Dark) No Preference 75 / 25 (Light / Dark) 50 / 50 (Light / Dark) 25 / 75 (Light / Dark) 100 (Dark) 100 (Light) Custom Strength Ready to Drink 4X (Espresso Strength) 10X Custom Quantity Custom Instructions Would you like us to include roasted coffee samples? Note: All bags are 12oz Any special instructions / notes? We’ve received your sample request! Maggie will send tracking information as soon as it’s available.