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Beauty Counter Samples Request
Hey! 
Thanks so much for reaching out to me about getting your hands on some Beauty Counter samples that will best fit your skincare needs. In order to get your samples please make sure that you are following my instagram account @essentially_courtneyleah. By filling out this form, you are agreeing to shop with Courtney Rogers as your Beauty Counter consultant and share your feedback after trying the samples in a timely manner! If you shop with another consultant, please each out to them to request samples.

I’m excited to chat with you and help you make the switch over to cleaner #betterbeauty! You can start browsing here - https://www.beautycounter.com/en-ca/courtneyrogers

Thanks so much 😊
Courtney

P.S. If you are already a client of mine, please feel free to DM me or email me at courtneyl_r@hotmail.com to request a sample!
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Your Name - First and last please *
Your full address *
Your email address  *
How old are you? *
How would you describe your skin type? *
What is your main skin concern? *
Do you have any other concerns? *
Have you had any reactions to any type of skin care products before? If yes, please tell me what products you used and what happend  *
Do you have a budget in mind for what you would feel comfortable spending? If yes, what range would you like to stay in? *
What samples would you be interested in trying? If you’re unsure, leave this blank and I will customize your samples based on your anwers above  *
Would you be interested in hearing about our makeup as well?
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If you are intereted in the makeup, please list below the products you’d like to switch out
Would you be interested in sharing an Affiliate link with friends? You’d have a chance to earn up to 5 free products and 5 50% off products!
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What best describes you?
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By filling out this sample request form, do you agree to shop with me as your Beauty Counter consultant and share your feedback with me regarding the samples?
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Lastly, please list any other concerns or questions you may have here
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