Please use this form to supply us with contact and shipping information along with the products that interest you.

If there are special shipping instructions, please note them in the "notes" section.

*** Important Notice Regarding Sample Requests ***
Milne’s Products are strictly Industrial Ingredients, which are intended for further product development testing and processing by our customers and prospects. They are not intended as retail finished products and will not be sampled as such.

Sample Request Form

   Shipping Information

Company Name:
Type of Industry:	Restaurant Manufacture of Beverages Manufacture of Sauces, Salad Dressing, Jams, or Jellies Manufacture of Confections (jellies, gummies, hard candy, etc.) Manufacture of Dairy Manufacture of Bakery (cookie & pastry fillings) Manufacture of Snack Foods (breakfast, energy, and meal bars, etc.) Other (please type a description)
Description:
Contact Name:
Address 1:
Address 2:
City:	State/Province: Zip:
Country:
Telephone:
Fax:
E-mail:
Ship Via:	Federal Express *
Notes:
	* Please note the following: All fields except notes are required. Samples will not be shipped to P.O. boxes. Shipping methods other than FedEx must be specified. Please note your requirements for samples larger than 8oz.

Products

Qty	Size	Brix	Product
1	8 oz. *
1	8 oz. *
1	8 oz. *
1	8 oz. *
1	8 oz. *