A Sample Request Form is designed to help businesses collect structured requests for product samples in a clear and organized way. This template allows requesters to submit their contact details, explain the reason for the request, select a preferred pickup date and time, and list one or more products they would like to receive as samples.

Using Fluent Forms, you can build this form with a custom HTML header for instructions or branding, followed by fields for name, email, and phone. The text area captures the reason for the request, while date and time fields allow users to schedule sample pickup. The repeat field lets requesters add multiple product entries, each including a masked input for product code, a text field for product description, and a numeric field for quantity. All submissions are stored in one place, making it easy to review, approve, and fulfill sample requests efficiently.

This Sample Request Form can be customized for warehouses, sales teams, distributors, or product-based businesses and works smoothly on any device.