Sample Request Form
Full Name *
Your answer
Address *
For us to mail the samples to you.
Your answer
Postal Code *
Samples are only mailed within Singapore.
Your answer
Mobile Number (Samples will only be sent after verification via SMS) *
For confirmation before sending samples.
Your answer
Email Address *
For confirmation before sending samples.
Your answer
Samples Catalogue *
Pictures below are for illustration and identification purposes only.
Please state size here if you are requesting for glove samples. Otherwise, leave it blank or indicate N/A.
Your answer
I will like to receive news & updates on products from Auxano Medical Pte. Ltd. *
Terms & Conditions
(a) Samples are while stock last only.
(b) Each unique phone number/mailing address is only allowed to request for up to 5 items.
(b) Samples will only be mailed within Singapore after SMS verification.
(c) Samples are free of charge and are not for sale/resale.
(d) Upon receiving the request, please allow 2 working days for processing and mailing via Singpost normal mail.
(e) Auxano Medical Pte. Ltd. is not liable for undelivered Singpost mails.
(f) Auxano Medical Pte. Ltd. reserve the rights to stop providing free samples without prior notice.
(g) Pictures below are for illustration and identification purposes only, they are not representative of the actual amount of samples you will be receiving. Please refer to the description of each choice for the actual amount of samples you are requesting for.

By submitting a sample request to Auxano Medical Pte. Ltd. ("Company") you,
(a) agree to the terms and conditions stated above; and
(b) consent the Company to use and retain your Personal Data for purposes of mailing samples to you as well as to provide news and updates on the Company's products; and
(c) acknowledge that if you are submitting a request on another person's behalf, you have obtained their consent to do so; and
(d) understand that you can opt out of news and updates on products from the Company at any point of time by sending us an email at; and
(d) understand that the Company reserves the right to amend the information at any time. The Effective Date stated below indicates the last time this was materially revised.

Effective Date: 31st August 2017

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