Sample Evaluation Request

Please fill out this form if you are interested in receiving a free sample (ReDe Mask - Adult). You may request up to 2 units. Please indicate the amount in the comments section. Your email address needs to be accurate so enter it carefully so that we can contact you if there are any issues and to let you know if the request has been approved.

We ask upon completion of your evaluation that you send us some feedback on your experience by emailing to

(* - required):

Name *
Company *
Address 1 *
Address 2
City *
State/Province *
Country *
Zip/Postal Code *
Phone *
Email Address *