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    Sample Request Form

    Please print out this Sample Request Form and fill in the information for where you would
    like the product sample(s) to be mailed.

    Please include a check to cover the costs of Shipping & Handling for:
                    $5.00 for 1 Planet Cooler®
                    $20.00 for 5 Planet Cooler®'s

Name     
Title     
Company     
Mailing Address   
(Please include   
Country, if   
applicable)   



Country     
E-mail Address     
Phone Number   
Is Required    		  

    Please provide your phone number if you are requesting that a sample be mailed to you.
    Requests without phone numbers provided will not be processed. Thank you for your
    cooperation!

    Please mail your completed form and check to cover the costs of Shipping & Handling to:

Cooler Concepts, Inc.
13055 15th Avenue North
Plymouth, MN  55441




 
                                                                       Cooler Concepts, Inc.
                                                                               13055 15th Avenue North
                                                                                     Plymouth, MN  55441
                                                                                                  763.278.0000
                                                                                            fax 763.278.0005
www.coolerconcepts.com                                        © 2000 Cooler Concepts, Inc.                        info@coolerconcepts.com