Request a Sample

Sample Product Name*
Name*
First Last
Company Name*
First
Email*
Enter Email Confirm Email
Phone*
Address*
Street Address Address Line 2 City State ZIP Code
Comments
Visit the Privacy Policy and Terms of Use pages within UconX website.*
I agree to the Privacy Policy and Terms of Use.
Visit the Privacy Policy and Terms of Use pages within UconX website.
The product sample is provided for qualification purposes only and not for resale. If more than one sample quantity of the same product and part number is needed, a deposit may be required. Limit one sample of the same product and part number per company unless approved otherwise by management. You are responsible for paying the shipping cost of the sample product(s).*
I have read and consent to the Product Sample Agreement below.
The product sample is provided for qualification purposes only and not for resale. If more than one sample quantity of the same product and part number is needed, a deposit may be required.

Limit one sample of the same product and part number per company unless approved otherwise by management.

You are responsible for paying the shipping cost of the sample product(s).