Sample Order Form

If you need a Sapmple, please submit your request using the below form in English.

Your Name (in English　Mandatory)
Please enter your last name, then first name in each of the following columns.

e-mail
Phone Number　（Mandatory）
Addres(in English　Mandatory)
Delivery Information (in English　Mandatory)
Delivery Adress
Delivery Facility Name
Contact person's phone number and name
Intended use of sample (in English　Mandatory)
EX 1. For the development of new skin care cosmetics.
EX 2. For cost reduction.
Estimated date of purchase (in English)
If you decide to use the raw material,When will you start to purchase it ?
Estimated annual usage (in English　Mandatory）
If you deicide to use the raw material ,How kilos per year would you purchase it ?
Products List　（Mandatory）
Please select the products which you want.
Multiple selections are possible. (Maximum 3 products)
Case of selecting others (in English)
If you select others,Please note the product name.
Consent to handling of personal information（Mandatory）
Please refer to the following address for our proper handling of specific personal Information.
General Policy Regarding the Proper Handling of Specific Personal Information | KANEDA Co., Ltd
URL