Sample request | Infinex

* Required Field

Request Infinex Samples

First Name

Last Name

Company

Email Address

Confirm Email Address

Project Name

Po Number

End Product Application

Estimated NPI Date

Estimated Start of Production Date

Estimated Annual Units

Production Site

Infinex Business Development Manager Contact

Ship Samples to

Shipment Courier

Courier Account Number

Shipment Method

Note: Transit time could change if there is a customs delay.

Business Name

Attention To

Phone Number

Address Fields

Address

Address 2

City/Town

State/Province

Zip/Postal Code

Country

Sample request form

	Customer Part Number (CPN)	Infinex MPN	Infinex MPN Description	Quantity Requested	Required Date	Weight
	Customer Part Number (CPN)	Infinex MPN	Infinex MPN Description	Quantity Requested	Required Date	Item weight

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