SAMPLE REQUEST | TAKACHI ENCLOSURE

*Notes* TAX or DUTY and all other local expenses charging at destination (if any) must be paid by Receiver.

Note that one time free sample request per customer/company and limited amount available.
The freight cost will be paid by a requester.

*Notes* TAX or DUTY and all other local expenses charging at destination (if any) must be paid by Receiver.

* Required field

Product Number(s) *	Multiple selection possible Please suffix Color code at the end of the number.
Purpose and Application *
Company name *
Your name*	Mr. Ms.
Address *
City *
State / Province *
Zip / Postal code *
Country *
CNPJ/CPF Tax ID	CNPJ/CPF Tax ID　are mandatory for request from Brazil or South Amarican countires.
Telephone *
E-mail *
Web site URL
Courier / Service Type		Account number
Courier / Service Type	If you do not have your own courier account, we will quote you some freight options we can offer.
Comment

*By clicking on SEND, you (the receiver) will agree to bear full responsibility for payment of any additional costs incurred (if applicable).

The information entered in the above form will not be used for any purpose other than our purpose based on our personal information protection policy.
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