Please complete as much as possible of the following details to request a sample of your product.

Note: a development deposit of NZ$1000 is normally required before your sample is supplied.
Aldwin Paige is happy to provide advice on packaging, distribution and marketing.

"Our success is based on yours"

*Required fields.

Last Name*	First Name*
Business Name	Email address*
Address	Telephone Number (inc. international code)*
Existing Products
How do you market your products? Retail Wholesale Internet	Other Please specify
What product/s would you like us to make for you?
Do you want us to develop the formulation?	If no (or maybe), what is the formulation?
If yes, what properties are you looking for in your product? Please describe in detail	If no (or maybe), what is the formulation?
	When do you plan to ask Aldwin Paige to start making the product?
What quantities would you expect to order once the product is developed?
Do you plan for us to package the product for you?
Are you going to supply raw materials?
Have you any other comments?