Sample Request

Customer Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Contact Number

E-mail

example@example.com

What type of fragrances do you like?

Fragrance generally evokes some type of emotion or feeling. What do your favorite smells make you think of or feel?

What interests you about Scentsy? Have you tried it before?

Are you interested in?

Trying a new Scentsy productSharing the products with friendsEarning free productsHearing more about earning money sharing Scentsy with friendsWould you like to be on my email list for discounts and monthly sales information?Do you want to know more about the Scentsy Club?

If you would like to be part of my birthday club put your birth date below.

Tell me one thing you'd like to do differently this year?

Send a sample to a friend. I'll tell them you gifted them a sample so they can thank you later! Provide their name, mailing address and email below

Thank you for completing this survey! I'll be sending you a sample of one of our products based on your answer.

Just for today CHOOSE TO BE HAPPY!

Peg Wilson, Star Director of Team Embrace

856-404-0076

BreathOfFreshAir.scentsy.us

GET ON MY SAMPLE LIST: