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FREE DIAPERS SAMPLE REQUEST FORM

 

Order Information (1 of 3)

This order is:   For me     For a family member     A gift   A donation

(Please check where applicable)

I would like to:

Diapers size:

 

Note 1-) We do not ship to P.O. Box

Note 2-) One free sample package per household

Shipping information * (2 of 3)

Please fill in all * required fields.

First Name:
Last Name:
Email:

Address:                            

 

Apt/Suite#

City:
State/Region:
Zip Code/Postal Code:
Phone:
()

How Did you hear about us:

Comments or questions


Submit information

I have read and agree to the free trial terms and conditions.

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Before you click the submit button

 

Please review your information, and make sure that

All necessary information has been filled out.
All information is error-free.

All information is correct and fraud-free.

 

For Fraud Prevention purposes, we have:

Recorded your IP Address

The time of your order submission

After you submit your order.  

Please come back to this page and finish the free trial period information.

THANK YOU.

 

Free trial period information (3 of 3)

 

  Accepted via PayPal (Easy and secure!)

 

We do NOT charge for the diapers sample.

We do NOT charge for the shipping.

We do NOT charge for the free trial period.

 

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