Please complete this form and press the Submit Request button to request a sample bottle.

Please note, that we will only send samples to addresses of valid educational establishments (not private home addresses) within The UK.

Please Send To:
First Name:	First Name is required. The maximum length of First Name is 45 chars.
Last Name:	Last Name is required. The maximum length of Last Name is 45 chars.
Email Address:	Email Address is required. Invalid format for Email Address.
School/Organisation:	School/Organisation is required. The maximum length of field is 45 chars.
Address:	First line of address is required. The maximum length of field is 50 chars.
Town:	Town is required. The maximum length of field is 30 chars.
County:	County is required. The maximum length of field is 30 chars.
Post Code:	Post Code is required. The maximum length of field is 12 chars.
Contact Number:
Please Send Me:	Bottle Size
	300ml Water Bottle Sample
	500ml Water Bottle Sample
	750ml Water Bottle Sample
	650ml Handle Water Bottle Sample
	Bottle Cap Colour
	Red Yellow Blue White Black Pink Green Please make a selection.
	Contact Number is required. The maximum length of field is 30 chars.